BERKELEY, CA (UroToday.com) - Haematuria is the most predictive single symptom of cancer, and its prompt investigation is mandatory.
Approximately 13% (9-16.6%) of patients presenting with haematuria are subsequently found to have urological malignancy.1,2,3,4 Dedicated haematuria clinics have been running for the last 3 decades, aimed at providing investigative service for patients with haematuria to decrease morbidity and mortality by earlier diagnosis of urological malignancy.
We have recently published an article on the outcomes and clinic process of the first 500 patients in a new “One Stop” Haematuria clinic (OSHC) in a Western Australian public hospital. This is the first haematuria clinic to run in a Western Australian public hospital. The results of our study confirmed that it is an efficient and effective model in the streamlined care of patients with haematuria. More than half of our patients were discharged after a single visit to the OSHC. In keeping with other published series 13% of the patients attending the clinic were diagnosed with cancer.
At the OSHC. patients have appropriate imaging, urologist’s review, and flexible cystoscopy all in one visit. Some patients would require further investigation and the results of the investigations would be followed-up by a nurse practitioner. If necessary, they would be brought back for further review. Otherwise, they would receive a telephonic follow-up to inform them of negative results.
This model of care is ideal for the public health system where resources are limited and there is an increasing necessity for efficient patient flow. Our data shows, excluding those who were waitlisted for surgery, that less than 5% of patients required further urologist follow-up. Although a formal cost-benefit analysis has not been performed, substantial cost savings to the hospital are self-evident. This streamlined service is also of relevance to the Western Australian rural population. They are often disadvantaged in access to cancer diagnostic services and frequently diagnosed at a later stage and face poorer prognosis compared to metropolitan patients.
It is still unclear why the model of the “One Stop” haematuria clinic is rarely adopted in the Australian health system despite evidence that it is successful. We encourage other centres in Australia to adopt this model of care, bearing in mind that the efficiency was achievable for the following reasons: triage of referrals, prior determination of best imaging, consultant-led assessment and diagnosis and nurse practitioner follow-up where appropriate.
- Khandra MH, Pickard RS, Charlton M, Powell PH, Neal DE. A prospective analysis of 1930 patients with hematuria to evaluate current diagnostic practice. J Urol 2000;163:524-7.
- Edwards TJ, Dickinson AJ, Natale S, Gosling J, Mcgrath JS. A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic. BJU Int 2005;97:301-5.
- Summerton N, Mann S, Rigby AS, Ashley J, Palmer S, Hetherington JW. Patients with new onset haematuria: assessing the discriminant value of clinical information in relation to urological malignancies. Br J Gen Pract 2002;52:284-9.
- Alishahi S, Byrne D, Goodman CM, Baxby K. Haematuria investigation based on a standard protocol: emphasis on the diagnosis of urological malignancy. J R Coll Surg Edinb 2002;47:422-7.
Wei Ling Ooi, MBChB and Dickon Hayne, MBBS, MD, FRCS(Eng), FRCS(Urol), FRACS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.