High-risk patients with hematuria are not evaluated according to guideline recommendations

Authors

  • Keren Elias BA,

    1. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Texas
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  • Robert S. Svatek MD,

    1. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Texas
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  • Samir Gupta MD,

    1. Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Texas
    2. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center at Dallas, Texas
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  • Richard Ho BS,

    1. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Texas
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  • Yair Lotan MD

    Corresponding author
    1. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Texas
    • Associate Professor of Urology, Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110
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    • Fax: (214) 648-8786


Abstract

BACKGROUND:

To determine whether high-risk patients with hematuria receive evaluation according to guideline recommendations.

METHODS:

We recently performed a screening study for bladder cancer using a urine-based tumor marker in 1502 subjects at high risk based on aged ≥50 years, ≥10-year smoking history, and/or a 15-year or more environmental exposure. We evaluated use of urinalysis (UA) within 3 years preceding the screening study. Chart review was performed to determine if this subset with microhematuria received any additional evaluation.

RESULTS:

Of 1502 study participants, routine urinalysis was performed in 73.2% and 164 (14.9%) subjects had documented hematuria (>3 red blood cells / high-power field) before inclusion. Of these, 42.1% had no further evaluation. Additional testing included repeat urinalysis (36%), urine culture (15.2%), cytology (10.4%), imaging (22.6% overall: 15.9% computed tomography, 4.3% intravenous pyelography; 2.4% magnetic resonance imaging), and cystoscopy (12.8%). Three subjects with microscopic hematuria (2%) were subsequently found to have bladder cancer during the screening study but were not referred for evaluation based on their hematuria. The source of hematuria was unknown in 65%, infection in 22%, benign prostatic enlargement in 10%, and renal stone disease in 4%, but these results are based on incomplete evaluation since only 12.8% underwent cystoscopy.

CONCLUSIONS:

Subjects at high risk for bladder cancer based on ≥10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria. Cancer 2010. © 2010 American Cancer Society.

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