Haematuria in Africa: is the pattern changing?

Abstract

Objective To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. Patients and methods The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7‐year period from 1985 to 1991. Results Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6–80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto‐urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). Conclusion Recurrent haematuria in patients over 30 years of age in this environment should be considered or deemed to be caused by malignancy until confirmed otherwise. An educational programme is required to alert the population to the significance of haematuria as a symptom demanding a thorough investigation before treatment. This would need support by a haematuria service for accelerated diagnosis and treatment.

Gross Hematuria and Urinary Retention Among Men From a Nationally Representative Survey in Sierra Leone

“…Reports from the early 1990s suggested that simply asking about subjective gross hematuria could serve as a screen for urinary schistosomiasis with improvements in sensitivity by adding clinician observation and reagent strips [20,21]. Studies over time, all based on individual clinics or hospitals in Nigeria, have shown schistosomiasis has become an uncommon cause of gross hematuria in the country with the emergence of BPH and urologic malignancies [8,22,23]. A clinic series of 100 adult patients found BPH, trauma, infection, malignancy, and calculi to account for 90% of cases [22].…”

“…A clinic series of 100 adult patients found BPH, trauma, infection, malignancy, and calculi to account for 90% of cases [22]. Hospital-based studies show roughly 30% of cases are due to BPH and 30% to urological malignancies [8,23]. Interesting disease-specific reports have demonstrated that over 40% of renal cell carcinomas present with the class triad of gross hematuria, flank pain, and a palpable mass and that the composition of urinary stones are moving toward that observed in industrialized countries [24,25].…”

“…Gross hematuria is much more concerning and may be secondary to an infectious etiology or nephritic/nephrotic conditions, but causes such as a renal calculus or malignancy require evaluation for potential surgical intervention. The epidemiologic etiologies of gross hematuria in Africa seem to have shifted in the past 50 years from schistosomiasis as the most common culprit to malignancy in the modern era [7,8]. However, there is no estimate for the general prevalence of gross hematuria in any LMIC.…”

UROLINK: a model for working together in a changing world

“…The need for an educational programme to alert people to the significance of haematuria as an event requiring investigation and, of course, the ability to respond to this, should be a high priority. The development of mobile diagnostic services to outlying hospitals and health centres is proposed as an appropriate way to tackle the issue in Nigeria [6].…”

UROLINK in sub‐Saharan Africa

“…Unfortunately, in older adults haematuria is not taken that seriously, so the diagnosis of bladder cancer may be delayed. The development or re‐development of haematuria in a person aged > 30 years should be investigated as carcinoma and not treated as a recurrence of bilharzia [5]. Consequently, bladder cancer (usually squamous cell carcinoma) is diagnosed late and is incurable by surgery or radiotherapy, the latter being available in only a few centres and not particularly effective.…”