SIU 2017: Identification of Factors Associated with Delayed Haematuria Assessment

Lisbon, Portugal ( While most causes of hematuria are benign or idiopathic, hematuria is the commonest presenting symptom of bladder cancer. A likely benign etiology may lead to delayed or inadequate hematuria assessment, subsequently affecting bladder cancer management in some patients. The authors attempted to identify factors that impact on the timeliness and adequacy of hematuria evaluation.

A retrospective cohort, identifying patients who underwent cystoscopy for investigation of hematuria during a 12 month period was analyzed. Exclusion criteria included age < 18 years, history of bladder/urinary tract/renal cancer and cystoscopy for indications other than hematuria. Primary outcome measures were:

 1) Time from general practitioner (GP) referral to urology consultation 
 2) Time from urology consultation to cystoscopy.
 3) Receipt of investigations in the 180 days prior to cystoscopy. 

Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes.

Over the study period, 308 eligible cases (228 males, 80 females) were identified. 196 (64%) patients were referred from the general practice setting. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time until urology consultation was 65 days for women and 33.5 days for men (P = 0.015). However, the observed difference between males and females was no longer statistically significant on multivariable regression analysis, and the only independent predictors of a shorter interval were macroscopic hematuria and suspicious findings on imaging. No gender difference was noted in regards to the investigations that hematuria triggered.

Gender was not shown to be a significant predictor of delayed hematuria assessment or receipt of recent investigations. Patients with macroscopic hematuria are were more likely to experience a faster review by urology physicians. Younger patients and those not on anticoagulation received fewer investigations. The authors conclude that additional education for physicians is required to ensure that patients with hematuria are evaluated appropriately.

Presented by: Marlon Perera
Affiliation: Royal Brisbane Hospital, Herston, 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

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