Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria

Abstract

ObjectiveTo identify factors that impact on the timeliness and adequacy of haematuria evaluation. Patients and MethodsWe undertook a retrospective cohort study identifying patients who underwent cystoscopy for investigation of haematuria at our institution between 1 January 2015 and 31 December 2015. Data on patient demographics, smoking status, anticoagulation, type of haematuria and referring clinician were collected. Exclusion criteria included patient age <18 years, known history of bladder/urinary tract/renal cancer, cystoscopy for indications other than haematuria and unknown date of urology consultation. Primary outcome measures were: i) time from general practitioner (GP) referral to urology consultation, ii) time from urology consultation to cystoscopy, and iii) receipt of investigations in the 180 days prior to cystoscopy. Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes. ResultsOver the study period, 305 eligible cases (225 men, 80 women) were identified, of which 196 (64%) were referred by a GP. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time to urology consultation was 65 days for women and 33.5 days for men (P = 0.020). However, the observed difference between men and women was no longer statistically significant on multivariable regression, with the only independent predictors of a shorter interval being visible haematuria and imaging suspicious for cancer. Anticoagulated patients were more likely to have imaging studies, in particular renal tract ultrasonography (P = 0.006), while only 61% of patients with visible haematuria received imaging. No significant differences in recent investigations between genders were observed. ConclusionsGender is not a significant predictor of delayed haematuria assessment or receipt of recent investigations. Anticoagulated patients are more likely to receive imaging than patients without anticoagulation and patients with visible haematuria are not adequately imaged. Improved clinician and public education is required to ensure that all patients are evaluated appropriately.

Delays in the diagnosis and initial treatment of bladder cancer in Western Australia

“…This strategy has the advantage of delivering a clear message to GPs precisely when they encounter a patient with haematuria, which for any individual GP is a relatively infrequent event. The high utilisation of MSU (96%) and upper tract imaging (82%) by GPs in the present study adds support to this approach, although we note lower utilisation of these investigations in a contemporaneous Australian series .…”

“…Our present treatment delay compares particularly favourably, although this may simply reflect the fact that cystoscopy occurred at initial assessment in our series (and therefore waiting time to diagnostic cystoscopy did not contribute to treatment delay as it did in other series). Although not directly comparable, our median assessment delay of 23.5 days compares favourably to a contemporaneous Australian series of 305 patients referred for investigation of haematuria . In that comparative series the median delay to initial assessment of patients with visible haematuria was 33 days, with these patients experiencing an additional median delay of 27 days to cystoscopy .…”

“…Although not directly comparable, our median assessment delay of 23.5 days compares favourably to a contemporaneous Australian series of 305 patients referred for investigation of haematuria . In that comparative series the median delay to initial assessment of patients with visible haematuria was 33 days, with these patients experiencing an additional median delay of 27 days to cystoscopy .…”

Bladder cancer diagnosis during haematuria investigation – implications for practice guidelines

“…However, a systematic review of the literature that we have recently undertaken has identified that patients with haematuria are inconsistently evaluated [2]. This finding was further corroborated in our study showing that many patients presenting to our institution with haematuria experience delays or gaps in their evaluations [3].A paucity of contemporary, evidence-based Australian guidelines, along with a lack of consensus among published guidelines worldwide may be important contributory factors. Thus, the AUA suggests cystoscopic evaluation for all patients with visible haematuria and those aged ≥35 years with nonvisible haematuria [4].…”

Evaluation of Social Reflex Resulting from Observation of Blood in the Urine

“…Hematuria is a clinical finding that can originate from anywhere in the urinary tract and can be the first sign of many diseases, including malignant diseases, of which prevalence may range from 4% to 19.3% (1,2). In clinical practice, hematuria comes out in two ways.…”