Bladder Tumor in Women with Microscopic Hematuria: An Iranian Experience and a Review of the Literature

Abstract

Aim. In this study we report our experience with microhematuria and its relation with bladder tumors in Iranian women. Materials and Methods. Overall 249 women were evaluated. Microscopic hematuria was defined as three or more red blood cells per high-power field on at least two different occasions. Patients with a history of gross hematuria or coagulation disorders, having organic diseases, urinary stones, urinary tract infections, nephrological diseases, and local lesions such as urethral caruncle were excluded from the study population. Final diagnosis of malignant tumors was done with cystoscopy and biopsy specimen pathological assessment in all cases. Results. Age for the study population was 49.7 ± 11.8 years. 95 (38%) of patients were identified during routine check up and presenting symptoms in other patients were frequency, dysuria, stress urge incontinence, urge incontinence, feeling of incomplete urine emptying, and flunk pain, respectively. Finally, 7 (2.8%) of study subjects were confirmed as having bladder tumors. One of tumor cases was diagnosed 24 months after initial assessments. Patients with bladder tumor were significantly older; more frequently had diverticulum in their bladder wall (P < .05). Conclusion. Female microscopic hematuria is relevant and deserves evaluations, especially in elderly patients. Patients whose reason for microhematuria would not be diagnosed at the initial evaluations should be followed.

Urothelial cancer rate in women with asymptomatic microhematuria. Is there a justification for full hematuria evaluation?

“…The incidence of bladder cancer in younger women with MH is very close to zero. While the cut-off age for low-risk women is somewhat variable, older age seems to correlate with higher risk in every study [2,10,[13][14][15] Nevertheless, it is important to point out the opposite point-of-view, where the prevalence of MH in women that were already diagnosed with bladder cancer is estimated at 17.8% [16].…”

Prevalence and associated factors for asymptomatic microscopic hematuria in adults in the PERSIAN Guilan cohort study (PGCS)

“…The 2020 American Urological Association ( AUA ) guideline recommends assessing risk factors for genitourinary malignancy, medical renal disease, and gynecologic and non-malignant genitourinary causes of microhematuria 2 . In Iran, many studies have been performed to determine the prevalence of AMH in different diseases, and they all suggested AMH as a significant sign for probable renal diseases and urothelial tumors that should be followed up with a standard diagnostic approach 12 – 15 . Unlike proteinuria, there is still much controversy on the natural course and clinical implications of AMH.…”