MICROSCOPIC HEMATURIA - UROLOGICAL INVESTIGATION USING A STANDARD PROTOCOL

Objective To determine which patients with asymptomatic microscopic ha ematuria (AMH) should be investigated to exclude significant urologica l pathology. Patients and methods The study comprised a prospective au dit of a standard protocol for investigating all patients referred wit h haematuria over one year in a haematuria clinic in the urology depar tment serving Tayside, Scotland. Investigations included urine culture and cytology, flexible cystoscopy, and upper tract imaging which cons isted of both excretory urography and renal ultrasonography in many of the patients. Results A total of 381 patients with microscopic haemat uria was investigated. No malignancy was found in any < 50 years of ag e (n = 131); in patients aged > 50 years the overall incidence of mali gnancy was 7.5% (19/250). The asymptomatic patients in this group had a lower incidence (5%, 6/126) of malignancy than the symptomatic patie nts (10.5%, 13/124) but this difference did not reach statistical sign ificance. There was no statistically significant difference in the inc idence of urological malignancy between men and in women with microsco pic haematuria. During the same period, 233 patients were referred wit h frank haematuria; in these patients, those aged (50 years had a 10% incidence of malignancy (6/60), while in those aged > 50 years the inc idence was 34.5% (60/173). A total of 18 patients.(4.7%) with microsco pic haematuria had upper tract calculi, comprising 5.3% (7/131) of pat ients aged < 50 years and 4.4% (11/250) of those > 50 years with micro scopic haematuria. Conclusions The investigation of older patients wit h microscopic haematuria (and all those with frank haematuria) is well justified, as malignancy will be found in a significant proportion ev en if they are asymptomatic. The benefit of a full urological investig ation of younger patients with microscopic haematuria is debatable.