Predicting Bladder Cancer Risk in Patients With Hematuria. A Single-Centre Retrospective Study

Every day in our clinical practice, be it in the emergency department or in urology appointments, we are confronted by a substantial number of patients with macroscopic hematuria. No doubts remain about the indication for additional assessment (with few exceptions), but how quickly should we do it? Our health resources are limited; therefore, the patient risk stratification is mandatory.

Based on clinical experience, it’s straightforward to distinguish the odds of bladder cancer between an 80 year old heavy smoker man with gross hematuria and a 40 year old nonsmoker woman with microscopic hematuria. However, for the cases that fall in between, we should be able to choose which patients need cystoscopy first, estimating the risk of bladder cancer risk, supported by strong scientific evidence.

In this study, we confirmed that male gender, older age, tobacco exposure, higher number of hematuria episodes and abnormal ultrasound results are statistically significant predictors of bladder cancer, that should raise our awareness. On the other hand, based on our results, the workup of a patient with a positive urine culture can be safely postponed.

Our study highlights the importance of the ultrasound as a screening test with a sensibility of 71% and a specificity .0of 87% to diagnose bladder cancer. But a normal ultrasound does not rule out the presence of a bladder cancer, as supported by the findings of bladder cancer in 16% of patients with normal ultrasound evaluation.

In our study population, 26.3% of the patients with hematuria were diagnosed with bladder cancer. It should be noted that the diagnosis was always based on histologic results from TURB, which remains the gold standard diagnostic tool.

In fact, notwithstanding the high accuracy of cystoscopy to diagnose suspicious bladder lesions, 15.4% of our population with suspicious cystoscopy had negative histology for bladder cancer after transurethral bladder resection (TURB).

Developing tools for estimating an approximate probability of bladder malignancy is essential to quickly treat those under major risk. More studies are needed to validate our empirical risk stratification and create an algorithm that can be widely applicable in clinical practice.

Written by: Roberto Jarimba, Vasco Quaresma, João Pedroso Lima, Miguel Eliseu, Edgar Tavares da Silva, Pedro Moreira, Arnaldo Figueiredo

Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculty of Medicine, University of Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculty of Medicine, University of Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculty of Medicine, University of Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculty of Medicine, University of Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra. Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra; Faculty of Medicine, University of Coimbra.

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