Urologist Use of Cystoscopy for Patients Presenting With Hematuria in the United States

David, Sam; Patil, Dattatraya; Alemozaffar, Mehrdad; Issa, Muta M.; Master, Viraj A.; Filson, Christopher P.

doi:10.1016/j.urology.2016.09.018

Cited by 20 publications

(17 citation statements)

References 20 publications

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“…Tissue biopsy may be done during cystoscopy. Cystoscopy is recommended in patients with a risk of malignancy in the urinary system (6).…”

Section: Discussionmentioning

confidence: 99%

“…Upper urinary tract can be examined by radiological methods but cystoscopy should be done especially for lower urinary tract evaluation (1). Cystoscopy should be recommended to hematuria patients with risk factor for urinary system malignancy, such as male gender, age over 35 years, and tobacco use (3,6). Although cystoscopy is an invasive procedure, it continues to be a reference standard in the evaluation of patients with asymptomatic microscopic hematuria (7).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Topuz¹,

Ebiloğlu²,

Kaya³

et al. 2019

jus

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Objective: Every day, many patients visit hospital due to hematuria. Ultrasonography and/or cystoscopy are performed in the initial evaluation and management. In this study, we compared ultrasonography and cystoscopy in the evaluation of microscopic or macroscopic hematuria. Materials and Methods: A total of 55 patients, who presented to our clinic with the complaint of hematuria between July 2016 and October 2017, were enrolled in this study. After obtaining informed consent, the patients were directed to urinary ultrasonography and cystoscopy for the evaluation of hematuria. Results: Ultrasonography showed 45 (81.8%) normal bladder and 10 (18.2%) masses, and cystoscopy detected 39 (70.9%) normal bladder and 16 (29.1%) masses in the bladder (p=0.001). Ultrasonography was able to report only 8 (50%) of 16 masses detected via cystoscopy. Two (20%) of 10 masses reported by ultrasonography were not confirmed through cystoscopy. The sensitivity and specificity of ultrasonography in detecting and excluding masses in the bladder were calculated to be 50% and 94.9%, respectively. Ultrasonography failed to detect lesions at the posterior, dome and right side and bladder neck. The cutoff value for blood cell count in urine to refer the patient to a cystoscopy procedure was detected to be 15 with 60% sensitivity and 50% specificity. Conclusion: With low sensitivity, ultrasonography could not offer enough knowledge about the bladder masses as sufficient as cystoscopy.

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“…Tissue biopsy may be done during cystoscopy. Cystoscopy is recommended in patients with a risk of malignancy in the urinary system (6).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Topuz¹,

Ebiloğlu²,

Kaya³

et al. 2019

jus

View full text Add to dashboard Cite

show abstract

“…The addition of Cxbladder test results for decision making was shown to enable patients with a high probability of UC to be identified and prioritized for a full urological work-up in advance of an initial consultation, offering a clear increase in clinical utility. This outcome is expected to be of significant importance in a healthcare system when there are challenges from < 14% of patients with hematuria being referred to a urologist within 180 days [ 15 ], and where approximately 20,000 instances of UC are missed annually in the US amongst patients with hematuria who are considered to be moderate-to-high risk [ 14 ]. Furthermore, approximately, one-third of patients with hematuria undergo a cystoscopy, providing the potential for approximately 200,000 potentially unnecessary cystoscopies performed on patients who have a low risk of UC every year [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, as few as 10% of women with hematuria are referred to urologists [ 14 ]. Likewise, < 14% of patients with hematuria undergo cystoscopy or radiological investigation within 180 days and a recent Australian study reported delays of up to 1165 days between initial presentation of hematuria and subsequent treatment for UC [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of a non-invasive urine test for risk assessing patients with no obvious benign cause of hematuria: a physician-patient real world data analysis

Lough¹,

Luo²,

Luxmanan

et al. 2018

BMC Urol

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BackgroundThe non-invasive Cxbladder urine test system has demonstrated clinical utility in ruling out urothelial carcinoma (UC) in patients with asymptomatic microscopic hematuria (AMH), suggesting that the number of invasive diagnostic tests, including cystoscopy, used in this patient population may be reduced by Cxbladder testing prior to conducting a full urological work-up. The aim of this study was to demonstrate the enhanced clinical utility of communicating objective information on diagnostic decisions made by individual physicians on individual patients with AMH.MethodsThree hundred ninety-six physician-patient decisions were generated from twelve participant physicians evaluating real world case notes from the same 33 patients presenting with AMH. Each physician reviewed and recommended diagnostic tests and procedures based on each patient’s referral data and then re-evaluated their clinical recommendation following disclosure of the non-invasive Cxbladder urine test result. Changes assessed were the total number of requested diagnostic procedures and the number of invasive procedures, including cystoscopy, following addition of information from Cxbladder in the Triage and Triage and Detect modalities.ResultsPhysicians made significant changes to their diagnostic behavior for patients with AMH when presented with Cxbladder test results, including a reduction in the number of total and invasive procedures including cystoscopy for individuals identified as having a low probability of UC. The intensity of investigation was targeted and increased, including use of total procedures and cystoscopy, for patients identified by Cxbladder tests as having a high probability of UC: urologists increased the level of investigation for both total procedures and invasive procedures. The outcome resulted in patients with a high risk of UC receiving appropriate guideline-recommended invasive diagnostic tests. Patients who tested negative were offered fewer and significantly less invasive procedures. This change in physician behavior results in an increased clinical and patient utility, lower risk of missed UC and invasive test-related harm incidents.ConclusionsThis study demonstrated the potential for increased clinical resolution and significantly enhanced patient management, when physicians consider Cxbladder test results in their clinical evaluation. The change in physician behavior led to more appropriate diagnostic procedure selection and resource allocation to the benefit of both patients and healthcare systems.Electronic supplementary materialThe online version of this article (10.1186/s12894-018-0327-6) contains supplementary material, which is available to authorized users.

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“…The take-home message for all of us is to at least know which machines are in use at the institutions where we work and their related laboratories, and try to influence the lab directors to calibrate their machines to a low number of RBCs (0-2 or 3) as the "normal group". Urologists are already somewhat derelict in performing cystoscopy in patients with microhematuria and increased risk factors for harboring urologic malignancies [6], and one would not want to increase this problem by relying on a relaxed or uncertain definition of microhematuria.…”

Section: University Of Rochester Medical Center Rochester Ny Usamentioning

confidence: 99%

Automated Urinalysis Machines: Potential Impact on the Diagnosis of Bladder Cancer

Messing

2019

BLC

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Urologist Use of Cystoscopy for Patients Presenting With Hematuria in the United States

Cited by 20 publications

References 20 publications

Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Clinical utility of a non-invasive urine test for risk assessing patients with no obvious benign cause of hematuria: a physician-patient real world data analysis

Automated Urinalysis Machines: Potential Impact on the Diagnosis of Bladder Cancer

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