BERKELEY, CA (UroToday Inc.) - During the BAUS annual meeting of 2003, questions arose regarding investigation of hematuria. J. F. Donahue and N. J. Barber of King's College Hospital, London subsequently conducted a mail survey on this subject and published their results in the British Journal of Urology International, January 2004 edition.

They received 212 responses out of 515 surveys sent, a return rate of 41%. In evaluating microscopic hematuria, most urologists (65%) imaged patients by using both abdominal ultrasonography and plain abdominal film. Fifteen percent preferred IVU alone, and 20% combined IVU with ultrasonography.

When they evaluated gross hematuria, 51% preferred ultrasonography plus IVU, 24% IVU only, and 25% ultrasonography only.

Fifty-eight percent of respondents routinely obtained cytology as a component of their evaluation (see also UroToday "Selective Cytology Usage... 1/22/04).

Flexible cystoscopy now permits office evaluation of many patients in the UK. When done, 62% of UK urologists would take office biopsies of suspicious areas, and 52% would treat in the office small tumor recurrences via the flexible cystoscope. The authors refer to "flexible cystodiathermy as a reasonable way" for treating these lesions.

What if no problems are found to explain hematuria? Then, urologists would "discharge" 88% of those with microscopic and 53% of those with macroscopic hematuria.

Some patients, however, continue with episodic bleeding even though found to be normal. In males, 98% of urologic consultants used finasteride for periods of at least 3 - 4 months to treat such patients. Fifty-seven percent continued it indefinitely. It has been shown to decrease blood loss after TURP, but only 4% of respondents used it prior to every TURP. Others (51%) used it selectively before certain complicated cases.

The authors conclude that, with regard to evaluation of hematuria, "great variations in practice remain". In addition, they note that use of finasteride to manage prostate-related hematuria in men with negative hematuria evaluations "has become part of many urologists' practice". Finasteride use prior to TURP seems less popular.

BJU Int. 2004;93:3-4