Nurse‐led one stop hematuria clinic: Outcomes from 2,714 patients

Abstract

Objectives Objective of this study is to report the results of nurse led hematuria clinic service outcome of 2,714 patients. Subjects and methods We conducted a retrospective, single center review of 2714 patients with visible and nonvisible hematuria managed by a well‐trained nurse specialist in a rapid access clinic (RAC) between 2014 and 2020. All patients received a full review, flexible cystoscopy performed by a nurse, and ultrasound of urinary tracts. After investigations, patients were reassured and discharged or referred for rigid cystoscopy, TURBT, and CT urography. Results In total, 2714 patients attended the RAC between October 2014 and March 2020. Of these, 1684 (62%) were males and 1030 (38%) females. The median age of patients was 68.3 (IQR 58‐79). Of the 1030 females, 500 (48.5%) presented with nonvisible hematuria (NVH), and 530 (51.5%) presented with visible hematuria (VH). The median age was 66 (IQR 56‐76). The number of females diagnosed with any form of malignancy was 72 (7% of all females). Of the 1684 males, 288 (17.1%) presented with NVH, and 1396 (82.9%) presented with VH. The median age was 72 (IQR 59‐81). The number of males diagnosed with some form of malignancy was 258 (15.3% of all males). Overall, 1926 patients presented with VH and 788 patients presented with NVH. After investigations, 290 patients (15.1%) with VH and 40 (5.1%) patients with NVH had some form of malignancy. The highest number of malignancies found in VH was bladder cancer (n = 222, 11.5%), followed by prostate (n = 28, 1%), renal (n = 23, 0.8%), UT urothelial (n = 17, 0.6%), gynaecological (n = 7, 0.3%), and gastrointestinal (n = 5, 0.2%) cancer. The highest number of pathologies found in NVH was infection (n = 44, 5.6%). Cancer detection rate for symptomatic NVH was more than double that of asymptomatic NVH, 6.5% versus 3.1%, respectively. Conclusion Overall, 15.1% with VH and 5.1% with NVH present with malignancy. Nurse‐led rapid access hematuria clinic and flexible cystoscopy investigation by trained nurse is safe and feasible.

Prevalence of prostate cancer in men with haematuria: a systematic review and meta‐analysis

“…In total, 65 studies were included in this review [20–84] (Table S1), and divided in two categories; (A) studies describing clearly how many of men referred to hospital or private practice for evaluation of haematuria aetiology had prostate cancer ( n = 42) [20–61], and (B) studies clearly describing haematuria as a presenting symptom leading to a prostate cancer diagnosis ( n = 23) [62–84]. The 42 studies describing evaluation of haematuria were included in a meta‐analysis [20–61]. All of the 42 studies […”

“…Almost all included studies reported performing either cystoscopy or imaging, or both, but as a DRE and PSA test are the initial clinical tests for the evaluation of prostate cancer, we enumerated the prostate cancer prevalence for studies that clearly described performing a DRE or PSA test on all included men (n = 11) [21][22][23][24]26,29,32,33,38,44,58]. In these 11 studies, the pooled prevalence (95% CI) of prostate cancer was 3.1% (1.9-4.5%; Fig.…”

“…To determine the significance of the organisation of haematuria diagnostic evaluation, we enumerated the prostate cancer prevalence for studies reporting results from specialised haematuria clinics (n = 12) [21,23,[25][26][27]29,38,[54][55][56][57][58]. In the remaining studies (n = 30), haematuria was handled in general urology departments, other hospital departments, or by GPs, and in some studies the setup was not described.…”

“…The prostate cancer prevalence in patients examined in a haematuria clinic (2.4%) seems lower than the pooled findings of this study (3.0%), probably due to the fact that these clinics' main focus is on bladder cancer diagnostics. Of the 12 studies reporting data from haematuria clinics (7979 men with haematuria), only six studies reported performing a DRE, PSA test or physical examination by a trained urologist on all included (2970 men with haematuria) [21,23,26,29,38,58]. Interestingly, the pooled prostate cancer prevalence (95% CI) of these six studies was 3.5% (1.7-5.9%) [21,23,26,29,38,58], indicating that performing a DRE and PSA test should be considered standard tests for all men attending a haematuria clinic.…”

BJUI Compass 2021 year‐end review

“…Interestingly, they were not able to show improved diagnostic performance when adding MRI to the ERSPC risk calculator. Stone et al 4 looked at the transperineal prostate biopsy method as a way to evaluate men with an abnormal MRI who might consider focal therapy. In this series, the transperineal was more of a saturation method and was positive in 53% for clinically significant disease.…”