The diagnostic value of macroscopic haematuria in diagnosing urological cancers: a meta-analysis

Abstract

The advice that all patients with macroscopic haematuria should receive a thorough diagnostic programme seems justified in a specialized setting, dealing with referred patients. At this moment no data are available to support or discourage a similar policy for GPs. Prospective studies on the diagnostic value of macroscopic haematuria for urological cancer in a primary care setting are urgently needed.

The association between symptoms and bladder or renal tract cancer in primary care: a systematic review

“…Eleven of these 56 papers were included in this review, [8][9][10][11][12][13][14][15][16][17][18] while 45 were excluded for the following reasons: narrative review (n = 15); patients, setting, or outcomes did not meet the inclusion criteria (n = 29); and not enough information available to ascertain relevance (n = 1).…”

The NICE primary care referral guideline for suspected bladder or renal cancer

“…11 Overall, the meta-analysis included data from five studies with a total of 70 330 patients, 3,4,[6][7][8] and showed that the PPV of visible haematuria for bladder or renal cancer was 5.1% (95% CI 3.2-8%). Such an overall estimate, derived from studies with age inclusion criteria spanning 15-100 years, is of limited use without at least subgroup analyses examining the effect of known risk factors, such as age and gender.…”

“…3 In general, the PPVs for visible haematuria increased with age in both cancers [11][12][13] and tended to be higher in males than in females. 4,8 In males, this started at 1% below 45 years of age, increasing to 4.4% (45-54 years), 8.5% (55-64 years), 11.2% (65-74 years), 10.3% (75-84 years) and 9.2% (85 years or above).…”

“…3,[11][12][13] However, as visible haematuria alone has a high enough PPV to warrant referral, the guideline development group was primarily interested in symptom combinations involving non-visible or no haematuria. The only such symptom combinations with PPVs above 1% were non-visible haematuria with abdominal pain (PPV = 1.7%), constipation (PPV = 2%), UTI (PPV = 1.4%), dysuria (PPV = 4.5%), raised inflammatory markers (PPV = 1.25%), raised creatinine (PPV = 1.1%) or raised white blood cell count (PPV = 3.9%), all for bladder cancer in patients aged 60 years or above, 11 and abdominal pain with microcytosis (PPV = >5%) for renal cancer in patients aged 60 years or above.…”

The impact of biomarkers in multivariate algorithms for bladder cancer diagnosis in patients with hematuria

“…1 Further compounding the problem in detection of bladder cancer is the fact that only 10% of patients with visible (''gross'') hematuria and 2% to 5% of patients with microscopic hematuria have bladder cancer. 2,3 Although these risks are not insignificant, identifying which patients have cancer is difficult because most patients with bladder cancer are asymptomatic at presentation. Furthermore, there is a very high prevalence of microscopic hematuria ranging from 9% to 18% in apparently normal individuals.…”