Long-term Outcome of Hematuria - Prospective Large Cohort
Hematuria accounts for a significant proportion of urology outpatient referrals. This prospective large cohort study with long-term follow-up aims to evaluate the outcomes for non-visible hematuria (NVH) versus visible hematuria (VH). The guidelines for hematuria are unclear.
Between 1999 and 2007, 2778 patients presenting with either NVH (974) or VH (1804) were investigated with upper tract imaging using ultrasound (U/S) and/or intravenous urography (IVU), computerised tomography (CTU), urine cytology and cystoscopy. Patient details, investigation results and clinical diagnoses were entered into a Microsoft Access hematuria database. The presenting features and range of pathologies detected were fully analysed. In 2017 a final analysis was performed using electronic patient records.
The findings for both NVH and VH included urinary tract infection, renal cysts, large bleeding prostates, renal tumours, bladder tumours, prostate cancer, urethral stricture / bladder neck stenosis and bladder calculi. In 63% of patients, no pathology was identified. The findings for NVH and VH were significantly different. In NVH patients 13.3% had benign pathology, 4.8 % had malignant pathology and 81% had no pathology. In the VH patients 31.9% had benign pathology, 21.9 % had malignant pathology and 50.3% had no pathology. None of the recurrent NVH that were re-investigated had a malignant diagnosis. However, more than 50% of recurrent VH had no pathology.
For the NVH group, the majority cleared by initial investigations remained asymptomatic. For the VH group, recurrence of VH indicated pathology in more than 50%. Therefore, vigilance and repeat investigation may be required in VH patients. As the findings in the NVH and VH groups were significantly different, investigations should be tailored to patient age and the type of hematuria. The Hematuria guidelines need to be refined.