Haematuria: from identification to treatment

Abstract

Haematuria has a prevalence of 0.1% to 2.6%. Potential diagnoses may include infection, kidney stones, trauma, exercise or spurious causes, such as foods, drugs or menstruation, and a tumour. Approximately 20% of patients with haematuria have a urological tumour, with a further 20% found to have a significant underlying pathology. Haematuria is subsequently known as the 'classic presentation' of bladder cancer with 70-80% of patients experiencing painless, gross (visible) haematuria. However, in all cases of visible haematuria, a tumour should be suspected until proven otherwise. A patient with visible haematuria requires urgent, stringent investigation, warranting specialist assessment and subsequent selective referral through a series of patient-centred investigations at a haematuria clinic. One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions. Yet despite morbidity and mortality from bladder cancer increasing, the haematuria service has remained largely unchanged for several decades. This paper will discuss the tests and investigations that need to be undertaken in an individual with either visible or non-visible haematuria, and outline the care that is needed to support patients through the investigation process, with special focus on bladder tumour.

Low Expression of hsa_circ_0018069 in Human Bladder Cancer and Its Clinical Significance

“…The diagnosis of bladder cancer is mainly confirmed based on the patient's symptoms, signs and clinical examination. Hematuria is a common symptom, but the incidence of gross hematuria in bladder cancer only accounts for 17% to 18.9% [ 27 , 28 ]. Ultrasound is valuable in diagnosis of bladder cancer, and transurethral bladder ultrasound shows high accuracy in tumor staging but is useless in the diagnosis of carcinoma in situ.…”

An early analysis of the cost-effectiveness of a diagnostic classifier for risk stratification of haematuria patients (DCRSHP) compared to flexible cystoscopy in the diagnosis of bladder cancer

“…Cystoscopy—the gold standard for bladder cancer detection [ 6 ], allows direct observation of the bladder, but is invasive and uncomfortable for the patient. Cystoscopy does not allow for upper track visualisation, does not always detect small areas of carcinoma in situ , can give false positive results, is embarrassing for the patient, and can be biased by the risk category of the patient [ 7 ]. Cytology, has high specificity, but poor sensitivity, and hence, cannot act alone for the diagnosis of urothelial cancer [ 8 ].…”

“…will have an increased prevalence of bladder cancer, while younger patients (<40 years) and those with limited risk factors (e.g. non-smokers) will be at less risk [ 7 ]. However, the latter would impact negatively on women who present with advanced stage bladder cancer [ 5 ].…”

Investigation of two week wait referred haematuria patients in the UK: A national survey

“…Haematuria is very common. Up to 2.6% 1,2 of the population will experience an episode of visible haematuria in their lifetime and the prevalence of asymptomatic non-visible haematuria varies from 0.9-22%. 2-4 There is a strong association with underlying urological malignancy therefore the National Institute of Clinical Excellence (NICE) suggests patients are referred urgently to secondary care for further investigation.…”