Is flexible cystoscopy necessary in the investigation of non-visible haematuria
BAUS ePoster online library. Nowers J. 06/21/21; 319077; p3-9
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Ms. Jennifer Nowers
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Abstract
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Introduction.
Historic data suggests ~5% of non-visible haematuria (NVH) referrals result in Urological cancer diagnosis. The majority are bladder cancers, for which flexible cystoscopy is regarded the 'gold standard' diagnostic procedure. Recent changes to suspected cancer referral guidelines, public information campaigns, and reduced smoking prevalence may have changed this percentage. We retrospectively calculated cancer detection rates from NVH referrals to assess whether flexible cystoscopy, an invasive and morbid procedure, was necessary.
Patients and Methods.
Clinical and demographic data were collected for all patients referred to our University teaching hospital on suspected cancer pathway with NVH over a ten-week period.
Results.
148 patients were referred (88 male, 60 female). Only seven (4.7%) had Urological cancers found (two renal and five bladder). Both renal, and three bladder cancers, were identified on imaging prior to flexible cystoscopy. Only two bladder cancers were detected by cystoscopy ('NNT' 74); one low-risk non-muscle invasive (patient has already been discharged) and one in a patient that was unfit for tumour resection (died of heart failure). Only seven (4.7%) of patients were offered the option of not undergoing flexible cystoscopy.
Conclusions.
Our data indicate that flexible cystoscopy is rarely of benefit in patients with non-visible haematuria. We suggest that patients should be given an accurate risk of bladder cancer diagnosis during the consent process. We advocate that flexible cystoscopy can be avoided for the majority of NVH referrals, particularly in low risk patients, i.e. non-smokers, young, and with no family or occupational risk factors for urothelial cell carcinoma.
Historic data suggests ~5% of non-visible haematuria (NVH) referrals result in Urological cancer diagnosis. The majority are bladder cancers, for which flexible cystoscopy is regarded the 'gold standard' diagnostic procedure. Recent changes to suspected cancer referral guidelines, public information campaigns, and reduced smoking prevalence may have changed this percentage. We retrospectively calculated cancer detection rates from NVH referrals to assess whether flexible cystoscopy, an invasive and morbid procedure, was necessary.
Patients and Methods.
Clinical and demographic data were collected for all patients referred to our University teaching hospital on suspected cancer pathway with NVH over a ten-week period.
Results.
148 patients were referred (88 male, 60 female). Only seven (4.7%) had Urological cancers found (two renal and five bladder). Both renal, and three bladder cancers, were identified on imaging prior to flexible cystoscopy. Only two bladder cancers were detected by cystoscopy ('NNT' 74); one low-risk non-muscle invasive (patient has already been discharged) and one in a patient that was unfit for tumour resection (died of heart failure). Only seven (4.7%) of patients were offered the option of not undergoing flexible cystoscopy.
Conclusions.
Our data indicate that flexible cystoscopy is rarely of benefit in patients with non-visible haematuria. We suggest that patients should be given an accurate risk of bladder cancer diagnosis during the consent process. We advocate that flexible cystoscopy can be avoided for the majority of NVH referrals, particularly in low risk patients, i.e. non-smokers, young, and with no family or occupational risk factors for urothelial cell carcinoma.
Introduction.
Historic data suggests ~5% of non-visible haematuria (NVH) referrals result in Urological cancer diagnosis. The majority are bladder cancers, for which flexible cystoscopy is regarded the 'gold standard' diagnostic procedure. Recent changes to suspected cancer referral guidelines, public information campaigns, and reduced smoking prevalence may have changed this percentage. We retrospectively calculated cancer detection rates from NVH referrals to assess whether flexible cystoscopy, an invasive and morbid procedure, was necessary.
Patients and Methods.
Clinical and demographic data were collected for all patients referred to our University teaching hospital on suspected cancer pathway with NVH over a ten-week period.
Results.
148 patients were referred (88 male, 60 female). Only seven (4.7%) had Urological cancers found (two renal and five bladder). Both renal, and three bladder cancers, were identified on imaging prior to flexible cystoscopy. Only two bladder cancers were detected by cystoscopy ('NNT' 74); one low-risk non-muscle invasive (patient has already been discharged) and one in a patient that was unfit for tumour resection (died of heart failure). Only seven (4.7%) of patients were offered the option of not undergoing flexible cystoscopy.
Conclusions.
Our data indicate that flexible cystoscopy is rarely of benefit in patients with non-visible haematuria. We suggest that patients should be given an accurate risk of bladder cancer diagnosis during the consent process. We advocate that flexible cystoscopy can be avoided for the majority of NVH referrals, particularly in low risk patients, i.e. non-smokers, young, and with no family or occupational risk factors for urothelial cell carcinoma.
Historic data suggests ~5% of non-visible haematuria (NVH) referrals result in Urological cancer diagnosis. The majority are bladder cancers, for which flexible cystoscopy is regarded the 'gold standard' diagnostic procedure. Recent changes to suspected cancer referral guidelines, public information campaigns, and reduced smoking prevalence may have changed this percentage. We retrospectively calculated cancer detection rates from NVH referrals to assess whether flexible cystoscopy, an invasive and morbid procedure, was necessary.
Patients and Methods.
Clinical and demographic data were collected for all patients referred to our University teaching hospital on suspected cancer pathway with NVH over a ten-week period.
Results.
148 patients were referred (88 male, 60 female). Only seven (4.7%) had Urological cancers found (two renal and five bladder). Both renal, and three bladder cancers, were identified on imaging prior to flexible cystoscopy. Only two bladder cancers were detected by cystoscopy ('NNT' 74); one low-risk non-muscle invasive (patient has already been discharged) and one in a patient that was unfit for tumour resection (died of heart failure). Only seven (4.7%) of patients were offered the option of not undergoing flexible cystoscopy.
Conclusions.
Our data indicate that flexible cystoscopy is rarely of benefit in patients with non-visible haematuria. We suggest that patients should be given an accurate risk of bladder cancer diagnosis during the consent process. We advocate that flexible cystoscopy can be avoided for the majority of NVH referrals, particularly in low risk patients, i.e. non-smokers, young, and with no family or occupational risk factors for urothelial cell carcinoma.
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