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. 2024 Mar;50(2):102-106.
doi: 10.5152/tud.2024.23025.

Urothelial Malignancy After Normal Hematuria Clinic Investigations: Does Non-visible Hematuria Need Reinvestigation?

Alice Thompson  1 , Bev James  2 , Rotimi David  3 , Mohamed Youseff  2 , Nicholas Gill  2 , Matthew Jefferies  2 , Pradeep Bose  2 , Gokul Kanda Swamy  2
Affiliations

Urothelial Malignancy After Normal Hematuria Clinic Investigations: Does Non-visible Hematuria Need Reinvestigation?

Alice Thompson et al. Urol Res Pract. 2024 Mar.

Abstract

Objective: Hematuria is the most common referral to Urology. Most initial evaluations are normal; however there are few medium- to long-term studies about these patients after they are discharged.

Methods: This study was a retrospective observational case-control study. Patients with normal initial investigations in our hematuria clinic (HC) over a 2-year period in 2012-2013 were included. We reviewed the electronic records of patients choosing January 1, 2021, as our reference date providing a median follow-up of 99 months. The primary aim of this study was to assess the missed urothelial malignancy (UM) rate in this cohort and also the UM rate in those re-referred to the HC.

Results: The study included 573 patients of whom 24.6% (141/573) were re-referred to urology during the study period. The overall missed UM cancer rate was 0.5% and 0.2% died as a result in this follow-up period. The UM cancer rate in those re-referred was 4.3% and of those re-referred with visible hematuria (VH) the UM cancer rate was 5.7%. No patients re-referred with non-visible VH (NVH) were diagnosed with UM. The only urological death during this time was due to UM.

Conclusion: All urological malignancy and mortality remain very low even at mediumto long-term follow-up after an initial normal HC investigation. In this study, no patients with recurrent NVH developed UM; therefore, recurrent NVH is unlikely to need reinvestigation. The risk of UM in those re-referred with VH is low but more substantial and warrants reinvestigation, which should include computed tomography urogram imaging.

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Conflict of interest statement

Declaration of Interests: The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Consort diagram. HC, hematuria clinic; NVH, non-visible hematuria; UM, urothelial malignancy; VH, visible hematuria.
See this image and copyright information in PMC

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