A prospective analysis of 2560 patients attending a protocol-based haematuria clinic

Haematuria represents one of the commonest conditions presenting to the urologist. It is accepted that?exible cystoscopy and some form of upper urinary tract imaging are mandatory in its investigation. Debate remains as to whether ultrasonography (US) or IVU is the imaging method of choice, and whether certain patients require imaging with both. We describe the findings in a prospective cohort of patients attending a protocol-based haematuria clinic. Manu nair urologist cancer uk london

PATIENTS AND METHODS

A total of 2560 patients (1699 men and 861 women, mean age 62.3 years, range 15-96) attended the clinic between May 1998 and December 2001. First-line investigations included history, examination, urine analysis, routine blood tests, US and?exible cystoscopy. IVU and urine cytology were used in patients with persistent haematuria where no abnormality had been detected on first-line tests.

RESULTS

Of the patients, 42% had microscopic and 58% macroscopic haematuria. Repeat urine analysis confirmed persistent microscopic haematuria in 44%. First-line imaging showed suspected benign abnormalities in 17% of patients and suspected malignant conditions in 9.1%;?exible cystoscopy showed bladder tumours in 294 (11.5%). IVU was used in 192 patients for further investigation of abnormalities on first-line tests and in 486 with persistent haematuria where no abnormality had been detected initially. Of these, 24 patients required further evaluation of abnormal IVU results, with only four requiring definitive treatment.

PATIENTS AND METHODS

A total of 2560 patients (1699 men and 861 women, mean age 62.3 years, range 15-96) attended the clinic between May 1998 and December 2001. First-line investigations included history, examination, urine analysis, routine blood tests, US and?exible cystoscopy. IVU and urine cytology were used in patients with persistent haematuria where no abnormality had been detected on first-line tests.

RESULTS

Of the patients, 42% had microscopic and 58% macroscopic haematuria. Repeat urine analysis confirmed persistent microscopic haematuria in 44%. First-line imaging showed suspected benign abnormalities in 17% of patients and suspected malignant conditions in 9.1%;?exible cystoscopy showed bladder tumours in 294 (11.5%). IVU was used in 192 patients for further investigation of abnormalities on first-line tests and in 486 with persistent haematuria where no abnormality had been detected initially. Of these, 24 patients required further evaluation of abnormal IVU results, with only four requiring definitive treatment.

CONCLUSIONS

Suspected benign or malignant conditions were detected on imaging in 26.8% of patients in this series; US detected 97.5% of these. IVU suggested abnormalities requiring evaluation in a further 24 patients (0.9% overall) with only five (0.2%) requiring treatment.

Manu Nair, a consultant urologist at Bupa Parkway Hospital in Solihull and Birmingham's Heartland and Solihull Hospitals, is the first in the West Midlands to offer the treatment. http://www.doctoralia.co.uk/consultant/nair+manu-11611313