SIU 2017: Predictors of Bladder Cancer Following Hematuria

Lisbon, Portugal ( Bladder cancer typically presents with painless hematuria, although only a minority will have underlying malignancy. The authors aimed to identify predictors of bladder cancer diagnosis following evaluation of hematuria, in order to formulate an appropriate approach to hematuria in Australia.

A retrospective cohort identifying adult patients undergoing cystoscopic procedures at our institution for investigation of visible hematuria over a twelve-month period in 2015 was analyzed. Patients with a known history of bladder/renal/urinary tract cancer were excluded. 

The sample comprised of 231 patients, of whom 39 (17%) were found to have bladder cancer, the youngest of these being 54.7 years old. Age at cystoscopy was the only independent predictor of bladder cancer diagnosis following multivariable analysis. The predicted probabilities of bladder cancer after adjustment for gender, socioeconomic status and Smoking status were: <1% at age <45 years, 13% at age 65 and 26% at age 80.

Some guidelines encourage investigating all patients with hematuria, although this imperative must be balanced against limited resource availability, leading others to be more selective. The findings of this elegant study demonstrate that the routine investigation of visible hematuria in patients aged >45 years is warranted, with a more individualized approach in younger patients and those with non-visible hematuria, which is in keeping with the most recent BAUS/NICE guidelines.

Presented by: Marlon Perera,  Australia

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal