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

Keren Elias, Robert S. Svatek, Samir Gupta, Richard Ho, Yair Lotan

Research output: Contribution to journalArticle

45 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2954-2959
Number of pages6
JournalCancer
Volume116
Issue number12
DOIs
StatePublished - Jun 15 2010

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Hematuria
Guidelines
Urinalysis
Urinary Bladder Neoplasms
Cystoscopy
Environmental Exposure
Smoking
Urine
Urography
Tumor Biomarkers
Early Detection of Cancer
Cell Biology
Erythrocytes
History
Tomography
Magnetic Resonance Imaging
Kidney
Infection

Keywords

  • Bladder cancer
  • Guidelines recommendations
  • Hematuria

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

High-risk patients with hematuria are not evaluated according to guideline recommendations. / Elias, Keren; Svatek, Robert S.; Gupta, Samir; Ho, Richard; Lotan, Yair.

In: Cancer, Vol. 116, No. 12, 15.06.2010, p. 2954-2959.

Research output: Contribution to journalArticle

Elias, Keren ; Svatek, Robert S. ; Gupta, Samir ; Ho, Richard ; Lotan, Yair. / High-risk patients with hematuria are not evaluated according to guideline recommendations. In: Cancer. 2010 ; Vol. 116, No. 12. pp. 2954-2959.
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