Evaluation of Asymptomatic Microscopic Hematuria by Renal Ultrasound to Detect Upper Tract Malignancy: A 20-Year Experience in a Community Hospital

Smith, Matthew R.; Read, Keaton C.; Stegman, Matthew L.; Kroll, Neil J.; Every, Marvin J. Van

doi:10.1016/j.urology.2019.07.009

Cited by 9 publications

(15 citation statements)

References 26 publications

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“…14 (12,15,16,(21)(22)(23)28,29,31,34,38,46,52,55) studies were prospective studies, of which 5 studies had a published protocol (21,23,25,46,55). Five studies were primary care studies (23,28,32,42,49), and 39 studies were secondary care studies. 17 studies were multicentre trials (17,20,22,23,25,28,29,31,32,34,(38)(39)(40)46,52,53,55)and 2 were studies from national registries (37,42) 3.2 Primary Outcomes 3.2.1 Incidence analysis VH 1.…”

Section: Description Of Studies (Table-1)mentioning

confidence: 99%

See 1 more Smart Citation

Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria

et al. 2022

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Section: Description Of Studies (Table-1)mentioning

confidence: 99%

“…17 studies had data available for incidence analysis (2,12,16,(26)(27)(28)(29)37,(39)(40)(41)43,44,47,49,53,55). The cumulative number of participants was 39,098.…”

Section: Rcc (Supplementary Figure-3)mentioning

confidence: 99%

Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria

et al. 2022

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“…In a retrospective study conducted by Smith et al, 2138 patients with asymptomatic microscopic hematuria underwent initial upper tract imaging with renal US performed by general sonographers under the supervision of radiologists. 13 The sensitivity of renal US for detecting RCC and upper urinary tract malignancy in this study was 100% with no additional lesions identified over a 3-year follow-up period. Three patients were diagnosed with upper tract UCC, and 9 were diagnosed with RCC.…”

Section: Discussionmentioning

confidence: 52%

The Diagnostic Yield of CT Urography in the Workup of Hematuria With Negative Cystoscopy

2020

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Purpose: To determine the diagnostic yield of computed tomography urography (CTU) in patients evaluated for hematuria with negative cystoscopy and to assess the added value of CTU when compared with ultrasound (US) in this patient population. Methods: A retrospective study was conducted of patients who underwent CTU within 12 months of negative cystoscopy for workup of hematuria at our institution from January 2016 to December 2017. Computed tomography urography findings were recorded and compared to clinical diagnoses to determine diagnostic yield. Computed tomography urography and US findings were compared in patients who underwent both examinations. Patient characteristics (age, sex, smoking history, and hematuria subtype) were reported. Results: A total of 657 patients met the inclusion criteria, including 108 patients aged 50 years and younger. No cause for hematuria was identified in 41% of patients overall and 58% of patients aged 50 years and younger. The most common diagnoses were benign prostatic hyperplasia and urolithiasis, accounting for 25% and 21% of patients, respectively; 0.6% of patients were diagnosed with an upper urinary tract malignancy, all older than 50 years. Although US was superior or equal to CTU for diagnosis in 83% of patients who underwent both examinations, US had a 0% sensitivity for detection of upper urinary tract malignancy. Conclusion: The low diagnostic yield of CTU and low prevalence of upper urinary tract malignancy in patients evaluated for hematuria with negative cystoscopy, particularly those aged 50 years and younger, call into question the appropriateness of multiphasic CTU as a first-line imaging modality in this population.

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“…There is little debate that CTU is the optimal upper-tract imaging modality for patients at high risk of UTUC, with a sensitivity and specificity of up to 96% and 99%, respectively [13]. While ultrasonography is considered to have reduced diagnostic accuracy and is more operator-dependent, with studies demonstrating a sensitivity ranging from 77% to 100% for diagnosing UTUC in patients with NVH, a recent study in patients undergoing both ultrasonography and CTU reported a 95.8% diagnostic accuracy for ultrasonography compared to 99.1% for CTU [14][15][16]. Despite the clear advantages of CTU for assessing the upper tracts, contrast CT imaging is associated with a significant risk of contrastrelated hypersensitivity reactions and secondary malignancies which should caution its routine use in younger patients presenting with NVH in whom the risk of secondary malignancy may be higher than that of underlying UTUC [14,17].…”

Section: Discussionmentioning

confidence: 99%

Optimizing Upper-Tract Imaging for Non-Visible Haematuria

et al. 2022

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Introduction: Non-visible haematuria (NVH) is associated with a small risk of upper-tract urothelial carcinoma (UTUC), though there is little consensus on its investigation, particularly with regard to upper-tract imaging. This study aimed to determine whether the presentation of UTUC can guide investigation of NVH in patients under 60 years old. Methods: All patients investigated at our one-stop haematuria clinics under a cancer pathway were reviewed during a 5-year period, with all patients undergoing cystoscopy and upper-tract imaging. Retrospective analysis of all UTUC cases from our urological cancer multidisciplinary team meeting database over a 10-year period was also undertaken. Results: 2,129 patients with a median age of 67 years underwent urgent investigation for haematuria between March 2015 and February 2020. 449 cases presented with NVH, of whom 124 (27.6%) were under 60. Out of 21 cases of UTUC, only 2 presented with NVH; both were over the age of 60 years. Factors that independently predicted diagnosis with urinary-tract malignancy were age ≥60 (OR 3.70, p < 0.001), visible haematuria (OR 2.50, p = 0.006), and suspicious cystoscopic findings (OR 58.06, p < 0.001). Review of all 119 UTUC cases over 10 years found 6 cases (5.0%) presenting with NVH, with one (0.8%) also presenting under 60 years. Conclusion: Diagnosis with UTUC is rare in patients presenting with NVH under the age of 60 years. Routine use of CTU in this low-risk group is best avoided, with ultrasonography constituting a safer first-line upper-tract imaging modality. Guidelines that risk-stratify NVH patients may be effective in reducing unnecessary investigations.

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Evaluation of Asymptomatic Microscopic Hematuria by Renal Ultrasound to Detect Upper Tract Malignancy: A 20-Year Experience in a Community Hospital

Cited by 9 publications

References 26 publications

Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria

Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria

The Diagnostic Yield of CT Urography in the Workup of Hematuria With Negative Cystoscopy

Optimizing Upper-Tract Imaging for Non-Visible Haematuria

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