Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy

Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review

“…The main bias and applicability concerns related to the suboptimal identification and/or adjustment for confounders in 18 of the studies, 6 of which were studies using questionnaires,14–19 10 were retrospective cohort studies providing descriptive statistics mainly, using record reviews (n=5)20–24 and electronic health records (n=5),25–29 1 was a case–control study30 and 1 an ecological study 31…”

“…For time to first evaluation including cystoscopy, upper urinary tract imaging or urine cytology, Garg et al used a threshold of 30 days,32 while two studies examined proportions of patients undergoing these tests within 6033 and 90 days 24. The remaining studies used 180 days as time cut-offs for which they considered evaluation should be carried out,22 28 34–36 although one also looked at completion within 365 years, and beyond 28. Thresholds for referral was set at 90 days by one paper,27 while delays in cancer diagnosis were defined as greater than 90 days37 and in 3 month increments up to 1 year 26 28…”

“…The remaining studies used 180 days as time cut-offs for which they considered evaluation should be carried out,22 28 34–36 although one also looked at completion within 365 years, and beyond 28. Thresholds for referral was set at 90 days by one paper,27 while delays in cancer diagnosis were defined as greater than 90 days37 and in 3 month increments up to 1 year 26 28…”

“…Eleven studies reported the percentages of investigations and referrals performed in patients with haematuria,18 21 22 24 25 28 33–36 38 seven of which also specified time-frames during which these evaluations should be completed22 24 28 33–36 (online supplementary appendix 2). Five studies reported that only 5%–25% of these patients received both imaging and cystoscopy (commonly defined as ‘complete evaluation’ by the studies) by 6 months of their first presentation with haematuria25 28 34–36 and case series of 100 patients in a single institution reported this percentage to be 64% in their cohort 22…”

“…Studies reported variations in the percentages of patients with haematuria who received urine culture (15%–84%), urine cytology (5%–43%), imaging tests (14%–76%) and cystoscopy (6%–26%) at at least 2 months after presentation, indicating that there were variations in how clinicians evaluate patients with haematuria. In studies that focused on the type of haematuria, a larger proportion of patients with VH (25%)25 received both imaging and cystoscopy than patients with non-visible haematuria (NVH) (up to 14%) 25 28 35. Between 21% and 36% of patients with haematuria received a urological referral,34 35 38 although a survey study from almost 800 PCPs in the USA reported that about one-third and two-thirds of them would refer patients with NVH and VH, respectively 18…”