Ambulatory and Office UrologyLong-term Outcome of Patients With a Negative Work-up for Asymptomatic Microhematuria
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
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Cited by (56)
Diagnostic yield of repeat evaluation for asymptomatic microscopic hematuria after negative initial workup
2021, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :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.
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.