The Significance of Adult Hematuria: 1,000 Hematuria Evaluations Including a Risk-Benefit and Cost-Effectiveness Analysis

Abstract

Between March 1976 and June 1985, 1,000 consecutive adults with asymptomatic gross or microscopic hematuria in the absence of proteinuria were evaluated urologically. Lesions that could account for the hematuria were detected in 88.3 per cent of the patients. Life-threatening lesions were diagnosed in 9.1 per cent of the patients, while lesions requiring at least observation were present in 22.8 per cent. The incidence of life-threatening lesions increased with age, with a sharp increase after age 50 years. Life-threatening lesions were more common in men (13.6 per cent) than in women (4.9 per cent). In general, as the degree of hematuria increased so did the yield of life-threatening lesions; however, there was no "safe" lower limit of hematuria. Of the patients with life-threatening lesions 18.6 per cent had at least 1 urinalysis with less than 3 red blood cells per high power field within 6 months of the diagnosis. The direct medical cost of a hematuria evaluation was $777. The difference in direct medical costs to diagnose and treat localized versus metastatic genitourinary cancer was $48,070 in 3 matched pairs of patients. In this study group 77 of 84 patients (92 per cent) diagnosed with genitourinary cancer had localized disease. A hematuria evaluation was cost-effective for all groups studied. A literature-based estimate of the life-threatening risks of diagnostic studies applied to the study data resulted in a 1.1 per cent life-threatening risk per hematuria evaluation. For all categories studied, except for women less than 40 years old with microscopic hematuria, the risk of a hematuria evaluation was less than the incidence of life-threatening lesions discovered as a result of the evaluation. Asymptomatic hematuria, whether gross or microscopic, is a significant finding and warrants evaluation from a risk-benefit and cost-effectiveness standpoint.

External Validation of a Clinical Scoring System for Hematuria

“…Hematuria is a common urological presentation, estimated to constitute 4-20% of all urological visits (Mariani et al, 1989). In the adult population, it can have different causes, such as urinary tract infections, urolithiasis, benign prostatic hyperplasia, urologic malignancies and secondary tumor invasion from other site (ex.…”

Hematuria in Children

“…In most people, the hematuria emanates from the lower urinary tract, especially in the conditions affecting the urethra, bladder and prostate. Less than 10% of hematuria is caused by glomerular bleeding [6].…”

Angiomatosis pélvica como causa de hematuria

“…La cistoscopia evidenciará el carácter unilateral de la hematuria 5 . La arteriografía es desde hace algunas décadas el procedimiento diagnóstico de elección; aún así un alto porcentaje de ellas no logra establecer la localización del hemangioma 3 . Cuando la arteriografía renal muestra la lesión, el tratamiento de elección es la embolización, siempre y cuando sea posible y seguro.…”

“…Aunque el tratamiento debe ser individualizado para cada paciente, los primeros pasos son claros: ecografía, citología, urografía intravenosa y/o TAC y cistoscopia 3 . Los avances en instrumentos endourológicos han cambiado drástica-mente el manejo de estos enfermos con lesiones en el aparato urinario superior, y así, la ureteropieloscopia, que ha sido múltiples veces ensayada con éxito en el tratamiento de los cálculos ureterales, ha alcanzado un valor incalculable para el diagnóstico y a veces tratamiento de lesiones pieloureterales 4 .…”