Half of Visible and Half of Recurrent Visible Hematuria Cases Have Underlying Pathology: Prospective Large Cohort Study With Long-Term Followup

Mishriki, Said Fadel; Vint, Ross; Somani, Bhaskar K.

doi:10.1016/j.juro.2011.12.100

Cited by 21 publications

(22 citation statements)

References 10 publications

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“…Haematuria is an extremely common presenting symptom for urological malignancy and many papers have been published regarding its PPV in diagnosing urological cancer. [3][4][5][6][7][8][9][10] However, most of the evidence involved patients who were reviewed electively in an outpatient setting. There are scant data assessing the diagnostic value of VH in the emergency setting.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying the risk of malignancy in patients with visible haematuria presenting to the emergency department

Gan¹,

Harris

Green

2014

Journal of Clinical Urology

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Haematuria is a frequently encountered presentation in the emergency department (ED). 1,2 Presentation of visible or macroscopic haematuria varies, including presence of clots, retention of urine and concurrence of pain. It may be due to a variety of causes, the most serious being underlying malignant pathology.The positive predictive value (PPV) of visible haematuria (VH) for urological cancer is 10%-22%. 3,4 Prospective cohort studies in United Kingdom (UK) protocol-driven haematuria clinics have revealed an incidence of malignant pathology in 19%-24% of patients with VH vs 3.7%-5.2% for non-visible haematuria. 5-8The majority of malignancies found are urothelial carcinoma (UC) of the bladder. AbstractIntroduction: Visible haematuria (VH) is a very common presentation to the emergency department (ED). In an outpatient setting, 18%-24% of such patients have been shown to have an underlying malignancy. The aim of this study is to determine the malignancy rates of patients presenting acutely to ED and whether the degree of bleeding or presence of clots is a higher risk factor for cancer. Method: We retrospectively collected data from adult patients (>18 years) presenting to ED with VH for a six-month period. Diagnostic outcomes after one year were assessed. Results: Our study population has 96 patients (male = 77, female = 19) with a mean age of 68 years (SD = 20.2). Twenty-eight patients (29%) had haematuria with clots. Twenty-five patients (26%) had a new diagnosis of malignancy, and 10 had a known diagnosis of malignant disease. Bladder cancer was the most commonly found malignancy, in 17 patients (15 new diagnoses), while prostate cancer was second with 14 cases (six new). Renal cancer two, testicular one and colorectal one accounted for the other new malignancies diagnosed following presentation. All but one patient with cancer were male. Although most malignancies were found in patients over 70 years old, the two youngest patients were in their 30s. The incidence of malignancy appears to increase in patients who have urinary blood clots (58%), p = 0.08. Conclusion: A third of patients presenting to ED with VH will have a urological cancer. Patients with VH and clots have a significantly higher incidence of malignancy. We recommend expedited referral of all such patients to a urologist.

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Section: Discussionmentioning

confidence: 99%

“…3,4 Prospective cohort studies in United Kingdom (UK) protocol-driven haematuria clinics have revealed an incidence of malignant pathology in 19%-24% of patients with VH vs 3.7%-5.2% for non-visible haematuria. [5][6][7][8] The majority of malignancies found are urothelial carcinoma (UC) of the bladder.…”

Section: Introductionmentioning

confidence: 99%

Quantifying the risk of malignancy in patients with visible haematuria presenting to the emergency department

Gan¹,

Harris

Green

2014

Journal of Clinical Urology

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“…To determine the significance of the organisation of haematuria diagnostic evaluation, we enumerated the prostate cancer prevalence for studies reporting results from specialised haematuria clinics (n = 12) [21,23,[25][26][27]29,38,[54][55][56][57][58]. In the remaining studies (n = 30), haematuria was handled in general urology departments, other hospital departments, or by GPs, and in some studies the setup was not described.…”

Section: Attending a Haematuria Clinicmentioning

confidence: 99%

Prevalence of prostate cancer in men with haematuria: a systematic review and meta‐analysis

et al. 2023

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To investigate the prevalence of prostate cancer in men attending evaluation for haematuria, as this could help healthcare providers to determine whether men with haematuria should have prostate examinations performed. MethodsThe study was performed according to a pre-specified protocol uploaded to the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022299383). A systematic search of MEDLINE, Ovid and Google Scholar was performed in December 2021. Two independent researchers evaluated all titles, available abstracts, and full texts. We included studies on adult men (aged ≥18 years) describing haematuria and prostate cancer. ResultsWe screened 4252 titles and abstracts when available and assessed 350 studies in full text. In total, 65 studies were included and 42 was summarised in a meta-analysis. In total, 18 752 men with haematuria were included, and the pooled prevalence (95% confidence interval [CI]) of prostate cancer was 3.0% (2.0-4.1%). In men with macroscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 5.9% (2.9-9.9%; n = 265/5373). In men with microscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 1.4% (0.8-2.2%; n = 71/6642). ConclusionOur findings indicate that the prevalence of prostate cancer is considerable in men attending evaluation for haematuria. Therefore, digital rectal examination and prostate-specific antigen measurement should become a standard procedure for all men with haematuria, especially for men with macroscopic haematuria.

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“…Consider re-referring these patients. A prospective large cohort study with long term follow-up found that investigations of recurring visible haematuria with previously negative findings resulted in diagnoses of urological malignancies in up to 11% of patients 15…”

Section: What You Should Domentioning

confidence: 99%

Visible haematuria

Madaan

Gandhi

Madaan

2022

BMJ

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Half of Visible and Half of Recurrent Visible Hematuria Cases Have Underlying Pathology: Prospective Large Cohort Study With Long-Term Followup

Cited by 21 publications

References 10 publications

Quantifying the risk of malignancy in patients with visible haematuria presenting to the emergency department

Quantifying the risk of malignancy in patients with visible haematuria presenting to the emergency department

Prevalence of prostate cancer in men with haematuria: a systematic review and meta‐analysis

Visible haematuria

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