IS IT TIME TO RE-DESIGN THE HAEMATURIA CLINIC?
Article first published online: 27 APR 2010
© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL
Volume 105, Issue 10, pages 1478–1479, May 2010
How to Cite
Bryan, R. T. and Wallace, M. A. (2010), IS IT TIME TO RE-DESIGN THE HAEMATURIA CLINIC?. BJU International, 105: 1478–1479. doi: 10.1111/j.1464-410X.2010.09395_1.x
- Issue published online: 27 APR 2010
- Article first published online: 27 APR 2010
We write in agreement with the comments of Mostafid et al.  in the March issue of BJU International. The principles of the haematuria clinic have now been with us for several decades [2,3], and such clinics have generally been responsible for reducing the delay in the diagnosis of urothelial cancers. But as the authors describe, some changes are required as we head further into the 21st Century .
Cancer registry data have shown an overall decline in bladder cancer incidence and mortality in Western communities [4–6], and this decline is likely to continue . However, over the last 20 years we have observed an increase in the median age of the bladder cancer population, with a significant increase in the proportion of patients now being newly diagnosed with this disease aged >80 years [RT Bryan, personal communication]. Other Western studies have reported similar changes during this period . These changes reflect the ageing population in the UK as a whole: since 1991, there has been a significant increase in the proportion of the population above state pension age, and this is projected to continue to increase to 2050 and beyond . Within this older population, the most substantial growth has occurred amongst the oldest old (those aged ≥85 years), which has resulted from the relatively high number of births that occurred in the first two decades of the 20th Century, combined with increased longevity at older ages . Therefore, we are likely to see an increase in the incidence of chronic kidney disease , which as the authors highlight , may present at the haematuria clinic. So now is the time for Urologists to consider the suitable evaluation of kidney disease in the haematuria clinic setting.
The authors also present evidence in support of the use of nuclear matrix protein 22 in the haematuria clinic . Molecular markers will become increasingly important for urothelial cancer diagnosis and prognostication as we continue through the century, with both conventional and novel experimental platforms providing robust and reproducible assays with high sensitivity and specificity, and point-of-care utility [10–12].
Finally, we think that cystoscopy will remain the ‘gold standard’ for detecting bladder cancer in the haematuria clinic for the near future . However, conventional white-light cystoscopy will evolve to embrace new imaging technologies with improved capabilities, such as narrow band and optical coherence tomography . This emphasises the continuing importance of not just performing, but teaching all trainees a ‘careful cystsocopy’, a fundamental technique in urology .
By optimising all of the modalities already at our disposal, and by embracing validated new technologies, we can make the Haematuria Clinic fit for the 21st Century.
- 4Cancer Research UK. Bladder cancer – UK incidence statistics (2006). Available at: http://info.cancerresearchuk.org/cancerstats/types/bladder/incidence/index.htm. Accessed April 2010
- 6European Network of Cancer Registries and the International Agency for Research on Cancer. , . Bladder Cancer in Europe. ENCR Cancer Fact Sheets September 2003: 3. Available at: http://www.encr.com.fr/bladder-factsheets.pdf. Accessed April 2010
- 8The changing age structure of the UK population. In: Focus On People and Migration, Chapt. 4. UK; Department Office for National Statistics, 2005: 61– 70, , , .