Canadian guidelines for the management of asymptomatic microscopic hematuria in adults

Wollin, Tim A.; Laroche, B; Psooy, Karen

doi:10.5489/cuaj.1029

Cited by 90 publications

(100 citation statements)

References 22 publications

(28 reference statements)

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“…3,[7][8][9][10] This certitude stems from strong evidence associating it with urologic malignancies. In fact, visible blood in the urine is thought to be the first presentation in 85% and 40% of patients with bladder and renal cancers, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…8 As such, in this setting, both the CUA and AUA recommend thorough physical examination, upper tract imaging with computerized tomography (CT), intravenous urography (IVU) or renal ultrasound, as well cytology and cystoscopic examination. 3,4 With that in mind, our first goal was to investigate how GPs would approach a patient with macroscopic hematuria and presented the case of a 45-year-old man with resolved asymptomatic gross hematuria and no evidence of infection. We were surprised to see that only 63.7% of the respondents elected to refer to urology for full investigation.…”

Section: Discussionmentioning

confidence: 99%

“…3 Similarly, the American Urological Association (AUA) defines it as 3 or more RBC/ hpf in 2 of 3 properly collected urinalysis specimens. 4 It is understood that gross hematuria should be investigated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system

Yafi

Aprikian

Tanguay

et al. 2013

CUAJ

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Background: Hematuria is one of the most common findings on urinalysis in patients encountered by primary care physicians. In many instances it can also be the first presentation of a serious urological problem. As such, we sought to evaluate current practices adopted by primary care physicians in the workup and screening of hematuria. Methods: Questionnaires were mailed to all registered primary care physicians across Quebec. Questions covered each physician's personal approach to men and postmenopausal women with painless gross hematuria or with asymptomatic microscopic hematuria, as well as screening techniques, general knowledge with regards to urine collection and sampling, and referral patterns. Results: Of the surveys mailed, 599 were returned. Annual routine screening urinalysis on all adult male and female patients was performed by 47% of respondents, regardless of age or risk factors. Of all the respondents, 95% stated microscopic hematuria was associated with bladder cancer. However, in an older male with painless gross hematuria, only 64% of respondents recommended further evaluation by urology. On the other hand, in a postmenopausal woman with 2 consecutive events of significant microscopic hematuria, only 48.6% recommended referral to urology. Findings were not associated with the gender of the respondent, experience or geographic location of practice (urban vs. rural). Interpretation: There seems to be reluctance amongst primary care physicians to refer patients with gross or significant microscopic hematuria to urology for further investigation. A higher level of suspicion and further education should be implemented to detect serious conditions and to offer earlier intervention when possible. Résultats : Sur tous les questionnaires envoyés, 599 nous ont été retournés. Une analyse d'urine annuelle systématique de tous les hommes et femmes adultes était réalisée par 47 % des répondants, peu importe l'âge du patient ou ses facteurs de risque. Sur tous les répondants, 95 % ont indiqué qu'une hématurie microscopique était associée à un cancer de la vessie. Cependant, chez les hommes âgés présentant une hématurie macroscopique sans douleur, seulement 64 % des répondants recommandaient une évaluation plus poussée par un urologue. En revanche, chez les femmes ménopausées présentant une hématurie microscopique significative lors de 2 évaluations consécutives, seulement 48,6 % des répondants ont recommandé de consulter un urologue. Les résultats n'ont pas été associés au sexe du répondant, ni à son niveau d'expérience ou la situation géographique de son cabinet (région urbaine ou rurale). Interprétation : Les médecins de premier recours semblent réti-cents à diriger vers un urologue pour des examens plus approfondis les patients présentant une hématurie macroscopique ou une hématurie microscopique significative. Il faut encourager les médecins de soins primaires à être plus vigilants et il faut leur transmettre plus d'information afin qu'ils soient en mesure de dépister des maladies graves et d'off...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system

Yafi

Aprikian

Tanguay

et al. 2013

CUAJ

View full text Add to dashboard Cite

show abstract

“…A minimum of 10 high-power fields were used. The definition of microscopic hematuria varies but this study used the most common definition; ≥3 erythrocytes per high-power field 5,6 . Hematuria on a dipstick was defined as ≥+1 (~25 erythrocytes/µL) for Siemens and ≥+2 (῀25 erythrocytes/µL) for Combur, according to the product information.…”

Section: Methodsmentioning

confidence: 99%

“…In recent years, it has become clear that the evidence for such an approach is weak [2][3][4] . Still many national guidelines 5,6 recommend urological examination for patients with asymptomatic hematuria, some even suggest a 36-month follow-up if an initial urological examination is negative 5 .…”

Section: Introductionmentioning

confidence: 99%