How and what to counsel patients with normal haematuria investigations?
BAUS ePoster online library. Thompson A. 06/22/21; 319011; p10-3
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Ms. Alice Thompson
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Abstract
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Introduction
Pathologies diagnosed among those evaluated for haematuria is well below 40%. We performed a study in those with normal investigations to evaluate long term outcomes.
Materials and Methods
We analysed patients who had normal investigations (Ultrasound, Flexible Cystoscopy) in haematuria clinic between Jan 2012 to Dec 2013. Reference date was 31st January 2021, ensuring at least 7 year follow up. We recorded demographics, haematuria type, additional investigations, re-referral pattern & mortality.
Results
The study population was 573 patients (M:F of 1.3:1). Ratio of Visible Haematuria (VH) and Non visible haematuria (NVH) was 2.74:1. More than two thirds had additional upper tract imaging but no additional urothelial malignancies were detected at this time. Among the 96.5% that were discharged, re-referral at 5 years and 7 years were at 18% & 24.9% respectively.
51% of re-referral was for haematuria. At 5 years, 3 new urothelial malignancies had been detected and none after the 5-year period. All these presented with VH at initial presentation and at least 2/3 at re-referral. Mortality went up from 12.9% at 5 years to 18.5% at 7 years with death due to urothelial malignancy was less than 0.2% over both time periods.
Conclusion
Urology specific mortality remains low even at 7 years after a normal HC investigation. Once a NVH is evaluated, there is no need to reinvestigate for NVH, at least for another 7 years even if it is persistent.
With longer follow up, likelihood of re-referral increases but detection of urothelial malignancy goes down.
Pathologies diagnosed among those evaluated for haematuria is well below 40%. We performed a study in those with normal investigations to evaluate long term outcomes.
Materials and Methods
We analysed patients who had normal investigations (Ultrasound, Flexible Cystoscopy) in haematuria clinic between Jan 2012 to Dec 2013. Reference date was 31st January 2021, ensuring at least 7 year follow up. We recorded demographics, haematuria type, additional investigations, re-referral pattern & mortality.
Results
The study population was 573 patients (M:F of 1.3:1). Ratio of Visible Haematuria (VH) and Non visible haematuria (NVH) was 2.74:1. More than two thirds had additional upper tract imaging but no additional urothelial malignancies were detected at this time. Among the 96.5% that were discharged, re-referral at 5 years and 7 years were at 18% & 24.9% respectively.
51% of re-referral was for haematuria. At 5 years, 3 new urothelial malignancies had been detected and none after the 5-year period. All these presented with VH at initial presentation and at least 2/3 at re-referral. Mortality went up from 12.9% at 5 years to 18.5% at 7 years with death due to urothelial malignancy was less than 0.2% over both time periods.
Conclusion
Urology specific mortality remains low even at 7 years after a normal HC investigation. Once a NVH is evaluated, there is no need to reinvestigate for NVH, at least for another 7 years even if it is persistent.
With longer follow up, likelihood of re-referral increases but detection of urothelial malignancy goes down.
Introduction
Pathologies diagnosed among those evaluated for haematuria is well below 40%. We performed a study in those with normal investigations to evaluate long term outcomes.
Materials and Methods
We analysed patients who had normal investigations (Ultrasound, Flexible Cystoscopy) in haematuria clinic between Jan 2012 to Dec 2013. Reference date was 31st January 2021, ensuring at least 7 year follow up. We recorded demographics, haematuria type, additional investigations, re-referral pattern & mortality.
Results
The study population was 573 patients (M:F of 1.3:1). Ratio of Visible Haematuria (VH) and Non visible haematuria (NVH) was 2.74:1. More than two thirds had additional upper tract imaging but no additional urothelial malignancies were detected at this time. Among the 96.5% that were discharged, re-referral at 5 years and 7 years were at 18% & 24.9% respectively.
51% of re-referral was for haematuria. At 5 years, 3 new urothelial malignancies had been detected and none after the 5-year period. All these presented with VH at initial presentation and at least 2/3 at re-referral. Mortality went up from 12.9% at 5 years to 18.5% at 7 years with death due to urothelial malignancy was less than 0.2% over both time periods.
Conclusion
Urology specific mortality remains low even at 7 years after a normal HC investigation. Once a NVH is evaluated, there is no need to reinvestigate for NVH, at least for another 7 years even if it is persistent.
With longer follow up, likelihood of re-referral increases but detection of urothelial malignancy goes down.
Pathologies diagnosed among those evaluated for haematuria is well below 40%. We performed a study in those with normal investigations to evaluate long term outcomes.
Materials and Methods
We analysed patients who had normal investigations (Ultrasound, Flexible Cystoscopy) in haematuria clinic between Jan 2012 to Dec 2013. Reference date was 31st January 2021, ensuring at least 7 year follow up. We recorded demographics, haematuria type, additional investigations, re-referral pattern & mortality.
Results
The study population was 573 patients (M:F of 1.3:1). Ratio of Visible Haematuria (VH) and Non visible haematuria (NVH) was 2.74:1. More than two thirds had additional upper tract imaging but no additional urothelial malignancies were detected at this time. Among the 96.5% that were discharged, re-referral at 5 years and 7 years were at 18% & 24.9% respectively.
51% of re-referral was for haematuria. At 5 years, 3 new urothelial malignancies had been detected and none after the 5-year period. All these presented with VH at initial presentation and at least 2/3 at re-referral. Mortality went up from 12.9% at 5 years to 18.5% at 7 years with death due to urothelial malignancy was less than 0.2% over both time periods.
Conclusion
Urology specific mortality remains low even at 7 years after a normal HC investigation. Once a NVH is evaluated, there is no need to reinvestigate for NVH, at least for another 7 years even if it is persistent.
With longer follow up, likelihood of re-referral increases but detection of urothelial malignancy goes down.
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