Evaluation of Hematuria in a Large Public Health Care System

Abstract

Background: Hematuria is the most common presenting symptom in bladder cancer, but many patients are not adequately evaluated. Objectives: To evaluate the type and frequency of hematuria evaluation in a large public health care system. Patients and Methods: Electronic medical records of adult patients with urinalysis positive for hematuria (≥3 RBCs/HPF) from January 2015 to April 2018 in an outpatient setting were reviewed. Logistic regression was performed to determine factors associated with urology referral and complete evaluation. Results: 11,422 patients met the inclusion criteria; the majority were females (72%) and white race (60%). There were an additional 3,221 patient's with initial diagnosis of UTI. Median age was 49.0 years. Testing included repeat urinalysis (50%), imaging (26%), urology referral (11.4%), cystoscopy (4.4%) and complete evaluation defined as cystoscopy and US/CT/MRI (4%). In the multivariable analysis, factors independently associated with higher referral to urology were age >35, male gender, hypertension, RBCs ≥20. African American race was associated with less referral to urology. Smoking was a significant variable on univariable analysis only. 37 patients (0.25%) were diagnosed with urological malignancies, with bladder cancer in 33, 12 of whom are missed by excluding UTI patients. Conclusions: In the outpatient setting of a public health care system, the vast majority of patients with hematuria are not referred and evaluated properly across all age categories and regardless of smoking status. This might result in missed cancer diagnoses and requires quality improvement measures.

Microhematuria: AUA/SUFU Guideline

“…In one large study, patients who had persistent MH on repeat urine testing had a higher rate of malignancy on subsequent evaluation as compared with those who had negative repeat urine testing. 37 According to the risk stratification schema above, patients with persistent MH are, therefore, re-classified as either intermediate-or high-risk for malignancy, in part dependent upon the degree of MH present at the repeat UA (table 4). Such re-classification ensures that patients with recurrent or persistent hematuria undergo a riskstratified evaluation.…”

Diagnostic Performance of Novel Urine-Based mRNA Tests (Xpert and Urinary Metabolomics Markers Assay) for Bladder Cancer Detection in Patients with Hematuria

“…Hematuria is the presenting symptom in the vast majority of bladder cancer (BC) patients [1]. The incidence of urological malignancies, primarily BC, diagnosed after work up for hematuria varies from 2-5% in the setting of persistent asymptomatic microscopic hematuria (AMH) in referred populations [2], reaching up to 10-20% in those with macroscopic hematuria [3]. Prompt evaluation of hematuria can lead to earlier BC diagnosis with possible improved survival [4].…”

The Consistency Testing and Improving of A Hematuria Colorimetric Card

“…The results showed that the clinical importance of hematuria colorimetric card was 4.80±0.41, including 4.80±0.42 for nurses, 4.60±0.52 for doctors and 5 for medical students. So, evaluators believe that hematuria colorimetric card is very important in clinical application, and medical personnel recognize that uni ed evaluation standard is important for clinical work although medical personnel still lack a uni ed evaluation standard of naked hematuria color grade [8][9] . For doctors, unifying the color standard of hematuria not only enable doctors to observe the process of patient's condition accurately and dynamically with different working years, but also bene t the effective information exchange between doctors and nurses, doctors and patients as well.…”