Ambulatory and office urologyDiagnosis of Urologic Malignancies in Patients with Asymptomatic Dipstick Hematuria: Prospective Study with 13 Years’ Follow-up
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
References (17)
- et al.
Home screening for hematuria: results of a multiclinic study
J Urol
(1992) - et al.
The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks
J Urol
(1987) - et al.
A community study of bladder cancer screening by the detection of occult urinary bleeding
J Urol
(1992) - et al.
Evaluation of asymptomatic microscopic hematuria
Urol Clin North Am
(1998) - et al.
The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis
J Urol
(1989) - et al.
A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice
J Urol
(2000) - et al.
Management of microscopic hematuria: twenty-year experience with 150 cases in a community hospital
Urology
(1986) - et al.
Strategies for asymptomatic microscopic hematuria: a prospective study of 1,034 patients
J Urol
(1990)
Cited by (49)
Label-free screening of common urinary system tumors from blood plasma based on surface-enhanced Raman spectroscopy
2024, Photodiagnosis and Photodynamic TherapyNon-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis
2020, European UrologyCitation Excerpt :Another prospective cohort study of 213 NVH patients with initially negative haematuria investigations had no diagnosis of cancer during 13 yr of follow-up. One patient re-presented 2 yr after discharge from clinic with visible haematuria, and the re-evaluation revealed BC emphasising the importance of re-evaluation of patients who develop new concerning signs or symptoms associated with a risk of urinary tract cancers such as VH [53]. In clinical practice, it is not uncommon to investigate persons who re-present after 12 mo with recurrent signs.
Haematuria
2019, Surgery (United Kingdom)Diagnostic evaluation of patients presenting with hematuria: An electronic health record-based study
2018, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :The prevalence of AMH is variable but estimated at 0.9% to 18% in the adult population [1]. Up to 20% of certain high-risk groups with AMH will be diagnosed with urologic cancer, including those with increasing levels of microscopic hematuria, increasing age, or smoking history [2–10]. In the absence of an obvious benign cause, AMH guidelines stress the importance of systematic and structured evaluation of all patients with cystoscopy and abdominal imaging.
Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines
2016, Urologic Oncology: Seminars and Original Investigations
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.