Elsevier

Urology

Volume 71, Issue 1, January 2008, Pages 13-16
Urology

Ambulatory and office urology
Diagnosis of Urologic Malignancies in Patients with Asymptomatic Dipstick Hematuria: Prospective Study with 13 Years’ Follow-up

https://doi.org/10.1016/j.urology.2007.08.031Get rights and content

Objectives

To appraise the outcomes, determine the natural history, and instigate a rationale plan for follow-up of patients with asymptomatic dipstick hematuria.

Methods

A total of 292 consecutive patients with asymptomatic dipstick hematuria referred between January1992 and December 1994 were investigated and prospectively followed up. The initial investigations included urinalysis, urine culture and sensitivity, cytology, intravenous urography, with or without ultrasonography, and cystoscopy. Baseline data and follow-up events, particularly the development of urologic malignancy, were recorded for a 13-year period.

Results

Sixteen patients (5.4%) were found to have urologic malignancies on initial evaluation. Of these, 11 died. During a follow-up of 13 years, 21 patients (7%) were lost to follow-up and 42 died of various unrelated causes (other than urologic malignancies). Of the remaining 213 patients, 180 (84.5%) subsequently had negative urinalysis. None with negative urinalysis developed a urologic malignancy during follow-up. The presence of dipstick hematuria persisted in 33 patients. Of these 33 patients, 10 had nephrologic causes, 8 had urinary tract infection, and 15 underwent repeat investigation with no pathologic cause identified. One patient, discharged with negative findings after full initial investigations, presented 2 years later with frank hematuria and was found to have a new bladder tumor.

Conclusions

Patients presenting with asymptomatic dipstick hematuria who have undergone thorough initial negative investigations can be discharged from tertiary urologic care services. Nephrologic referral is recommended if dipstick hematuria and proteinuria persist. The repetition of the urologic investigations is unwarranted, unless patients present with symptoms or develop frank hematuria.

Section snippets

Material and Methods

A total of 292 consecutive patients with asymptomatic dipstick hematuria were referred to the urology clinic from 1992 to 1994. The reagent used for urine testing was 0.4% wt/wt diisopropylbenzen dihydroperoxide; 4.0% wt/wt 3,3, 5,5′-tettramethylbenzidine; 48.0% wt/wt buffer; 41.2% wt/wt nonreactive ingredients as a reagent with a sensitivity of 150 to 620 μg/L hemoglobin, approximately equivalent to 5 to 20 intact red cells/mL. Dipstick hematuria was considered present if, on testing the urine

Results

The outcome of the initial investigations for the 292 patients is summarized in Table 1. In 73% of patients, dipstick hematuria was confirmed on urine microscopy. In 128 patients (44%), no pathologic finding was detected on the initial evaluation. No malignancy was found in any patient younger than 50 years of age. At the 13-year follow-up period, the data for 21 patients were not available (patients lost to follow-up); 42 patients had died of unrelated, mainly cardiovascular, causes; and 16

Comment

A full urologic investigation, including upper tract imaging and cystoscopy, is recommended for patients presenting with dipstick hematuria7; however, the clinical importance of asymptomatic microhematuria has also been questioned. A complete investigational workup can determine a cause in 32% to 100% of cases, and significant pathologic findings causing dipstick hematuria have been reported in 3.4% to 56% and malignancy in 1.2% to 26%.6 In the present study, 16 patients (6.6%) were diagnosed

Conclusions

The findings from this study with long-term follow-up suggest that the risk of urologic malignancies in patients with negative findings from initial full urologic investigations for asymptomatic dipstick hematuria is very low. These patients can safely be discharged from urologic care. Positive dipstick urinalysis in patients who have had previous negative investigations for dipstick hematuria does not warrant additional urologic investigations unless the patient is symptomatic or presents with

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This study was presented as a poster presentation as “Microscopic Hematuria—11-Year Prospective Follow-up Study” at the British Association of Urological Surgeons, Glasgow, June 2005; and as a poster presentation as “Dipstick Hematuria—13-Year Prospective Follow-up Study” at the American Urological Association Annual Meeting, Anaheim, California, May 2007.

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