Evaluation of Hematuria in Adults

Sutton, James

doi:10.1001/jama.1990.03440180081037

Cited by 154 publications

(85 citation statements)

References 70 publications

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“…[5]. However, evaluation of persistent asymptomatic microscopical haematuria has revealed a 20-30% likelihood of finding a significant urologic disease, especially when elderly population is screened [6]. From our investigation, it seems that pure dipstick screening has a potential danger of missing inflammatory and other kinds of urinary tract diseases.…”

Section: Letter To the Editormentioning

confidence: 73%

Rapid dipstick urinalysis in the internal medicine clinic: what is missed?

Laine¹,

Toivonen²,

Eklund³

et al. 1997

Journal of Internal Medicine

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Section: Letter To the Editormentioning

confidence: 73%

Rapid dipstick urinalysis in the internal medicine clinic: what is missed?

Laine¹,

Toivonen²,

Eklund³

et al. 1997

Journal of Internal Medicine

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“…In addition, the procedure has been associated with pain or discomfort in about a third of cases (Van Der Aa et al, 2008). Due to concerns about the number of unnecessary diagnostic evaluations as well as the low prevalence of bladder cancer in the general population (Sutton, 1990), screening is not currently recommended.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Clinical Scoring System for Hematuria

Lee

Kim

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The aim of this study was to evaluate the accuracy of a new scoring system in Korean patients with hematuria at high risk of bladder cancer. Materials and Methods: A total of 319 consecutive patients presenting with painless hematuria without a history of bladder cancer were analyzed, from the period of August 2012 to February 2014. All patients underwent clinical examination, and 22 patients with incomplete data were excluded from the final validation data set. The scoring system included four clinical parameters: age (≥50 = 2 vs. <50 =1), gender (male = 2 vs. female = 1), history of smoking (smoker/ex-smoker = 4 vs. non-smoker = 2) and nature of the hematuria (gross = 6 vs. microscopic = 2). Results: The area under the receiver-operating characteristic curve (95% confidence interval) of the scoring system was 0.718 (0.655-0.777). The calibration plot demonstrated a slight underestimation of bladder cancer probability, but the model had reasonable calibration. Decision curve analysis revealed that the use of model was associated with net benefit gains over the treat-all strategy. The scoring system performed well across a wide range of threshold probabilities (15%-45%). Conclusions: The scoring system developed is a highly accurate predictive tool for patients with hematuria. Although further improvements are needed, utilization of this system may assist primary care physicians and other healthcare practitioners in determining a patient's risk of bladder cancer.

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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%

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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Evaluation of Hematuria in Adults

Cited by 154 publications

References 70 publications

Rapid dipstick urinalysis in the internal medicine clinic: what is missed?

Rapid dipstick urinalysis in the internal medicine clinic: what is missed?

External Validation of a Clinical Scoring System for Hematuria

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

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