PURPOSE: To report the incidence of urinary tract malignancies (UTM) and to compare the diagnostic accuracy of cytology with cystoscopy, renal ultrasound (US) and computed tomography (CT) in patients with hematuria. METHODS: A retrospective analysis was conducted of patients who underwent cystoscopy, cytology, US and CT for hematuria between 2011 and 2017. Age, gender, BMI, smoking status, and results of further diagnostic interventions including transurethral resection of the bladder (TURB), ureterorenoscopy (URS), renal biopsy and imaging were extracted from medical charts. Logistic regression to identify risk factors for UTM was performed. Discriminatory accuracy of US, CT and cytology was assessed by 2 × 2 tables. RESULTS: Of 847 patients, 432 (51%) presented with nonvisible hematuria (NVH) and 415 (49%) with visible hematuria (VH). Of all patients with NVH, seven (1.6%) had bladder cancer (BCA), three (< 1%) had renal cell cancer (RCC) and no single patient had upper tract urothelial cancer (UTUC). Of the patients with VH, 62 (14.9%) were diagnosed with BCA, 7 (1.6%) with RCC and 4 (< 1%) with UTUC. In multivariable analysis VH, higher age, smoking and lower BMI were associated with an increased risk for UTM. The specificity/negative predictive value of US for the detection of RCC or UTUC in patients with NVH and VH were 96%/100% and 95%/99%, respectively. CONCLUSION: Due to the low incidence of UTM, the necessity of further diagnostics should be questioned in patients with NVH. In contrast, patients with VH are at considerable risk for BCA, and cystoscopy and upper tract imaging is justified.
a single academic referral center. All patients undergoing resection for penile or scrotal SCC or CIS were included. Demographics, Mohs procedure details, pathologic staging, and need for adjuvant oncologic surgery or reconstructive surgery were reviewed. RESULTS: Of 148 cases undergoing GU Mohs, 99 patients were included who had 108 discrete lesions removed. Among cases with penile cancer, glans involvement (p<0.001) and lesions 3 cm or larger (p[0.002) were more likely to be referred after Mohs for formal reconstruction. Inability to clear the lesion with positive margins was strongly correlated with referral for more aggressive cancer management (p<0.001), and while not statistically significant, there was indication that patients with high risk pathologic features were referred for further oncologic management (T1b or higher penile cancer, p[0.056). Resection of recurrent tumors was not associated with referral after Mohs (p[0.30). Fourteen patients underwent skin grafting and 16 were closed with tissue flaps, while 10 were closed primarily after referral.CONCLUSIONS: Mohs can be considered for aggressive tissue preservation in appropriately selected low risk patients, but a significant fraction of patients will require more advanced reconstruction. Patients with lesions located on the glans or large shaft lesions and possibly patients with more aggressive pathology are more likely to require a second operation. These patients may be well served with a collaborative, multi-specialty approach aimed at optimizing resection with coordinated planned reconstruction from the earliest planning stages.
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