Elsevier

Urology

Volume 75, Issue 1, January 2010, Pages 20-25
Urology

Ambulatory and Office Urology
Long-term Outcome of Patients With a Negative Work-up for Asymptomatic Microhematuria

https://doi.org/10.1016/j.urology.2009.06.107Get rights and content

Objectives

To assess the validity of the American Urological Association guidelines, we investigated 14-year outcomes of men aged ≥50 years who had hematuria detected in a bladder cancer (BC) screening trial, were thoroughly evaluated, and were not found to have urological cancers. The American Urological Association guidelines for follow-up of adults with asymptomatic microhematuria (MH) who have negative evaluations include repeat urinary cytologies, urinalyses, and office visits for several years, primarily to detect BC (Cohen and Brown, N Engl J Med 348: 2330-2338, 2003; and Grossfeld et al, Urology 57:604-610, 2001).

Methods

Of 1575 screening participants, 258 had MH detected by daily home testing with the Ames hemastix during two 14-day periods. This test has been shown to accurately reflect MH on microscopic urinalysis when each is correctly performed. Any man with at least 1 positive test (≥“trace”) underwent a complete evaluation including microscopic urinalysis, culture, cytology, complete blood count, serum creatinine, coagulation profile, intravenous urography or computed tomography scan, and cystoscopy. BC or other urological tumors was not detected in 234 participants. Using Wisconsin state tumor registry and death certificate data, the outcomes of these men were tracked for 14 years since their last testing.

Results

Two of the 234 men (0.85%) developed BC during the 14-year follow-up, at 6.7 and 11.4 years after their negative evaluations; one died of BC 7.6 years after his last screening. During this follow-up, 0.93% of the screenees who tested negatively for hematuria had BC diagnosed, none within a year of their last testing date.

Conclusions

Patients who have negative complete evaluations for asymptomatic MH have little chance of subsequently developing BC. The recommended “appropriate” follow-up for these patients may require reconsideration in light of these data.

Section snippets

Material and Methods

The methods of the screening, characteristics of the cohort, and outcomes of those with screening-detected BC were reported previously.11 Briefly, men aged ≥50 years who were identified from well-patient clinic rosters in and around Madison, WI, were solicited to take part in a screening study to detect BC using chemical reagent strips for hemoglobin. Solicited subjects were asked to test their urine at home repeatedly according to 1 of 2 different protocols: 5 daily testings and then 1

Results

For both screening studies, a total of 3515 men were solicited and 1575 (44.8%) participated. In the 1987 pilot study, 235 men tested their urine at home using Hemastix and 1340 similar men recruited from a broader geographic base tested between 1989 and 1992. A total of 258 (16.4%) of the participants had at least 1 positive test and were evaluated. Twenty-one (8.1%) had BC detected and are the subject of a recent report that demonstrated that screening may reduce mortality from BC compared

Comment

Hematuria remains the most common presenting sign and symptom of BC. Unfortunately, mortality from the disease has not significantly declined over the past 20 years since this study was initiated.14 Although screening for hematuria has not been advocated for any given population, data indicate that recognition of the potential seriousness of hematuria and its intermittent nature, are not well appreciated by primary care physicians.15 Because therapy for advanced BC has improved little in terms

Conclusions

BC-induced hematuria is highly intermittent and at least in men aged ≥50 years, a single positive urinalysis justifies a thorough evaluation to rule out the presence of BC. However, after this evaluation is performed and the result is negative, in the absence of gross hematuria or other symptoms suggestive of BC, it is difficult to justify repeated evaluations or even monitoring. Such patients with asymptomatic MH and a negative work-up have <1% chance of subsequently developing BC in our

References (24)

  • Guide to Clinical Preventive Services

    (1996)
  • G. Nabi et al.

    Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up?

    J Clin Pathol

    (2004)
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      One Japanese cohort study observed that 0.7% (3/421) of patients who had an initially negative AMH workup with cystoscopy and upper tract imaging were diagnosed with bladder cancer within 3 years of initial workup [17]. In another study of 234 men over 50 years old from Wisconsin who had negative initial upper tract imaging, cystoscopy, and cytology, 2 (0.85%) men who were both former smokers developed bladder cancer at 6.7 and 11.4 years after their initial negative evaluation [13]. Lastly, a study from the United Kingdom of 687 patients who had a negative hematuria evaluation, including upper tract imaging and cystoscopy, observed that at 4-year follow-up, 10 (1.5%) patients were found to be later diagnosed with urologic malignancies, including 7 new bladder cancers and 3 upper tract tumors.

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    Supported in part by grants from the State of Wisconsin Division of Health and Social Services and from the Ashley Family Foundation.

    Ralph Madeb was supported in part by the Empire State Grant.

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