A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice

Purpose: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVP) and cystoscopy. Some have suggested that ultrasou nd of the upper urinary tract is adequate and that cystoscopy is not necess ary in younger patients with microscopic hematuria. We ascertain whether a less intensive algorithm could be adopted while retaining diagnostic effica cy. Materials and Methods: A total of 1,930 patients were enrolled prospectivel y in the study at a hematuria clinic between October 1994 and March 1997. E valuation consisted of basic demographics, history and examination, routine blood tests, urinalysis and cytology. All patients underwent plain abdomin al radiography, renal ultrasound, IVP and flexible cystoscopy. Results: A total of 1,194 males and 736 females with a mean age of 58 years (range 17 to 96) were included in the study. Overall, 61% of patients had no basis found for hematuria, 12% had bladder cancer, 13% had urinary tract infection and 2% had stones. Kidney and upper tract tumors were noted in 1 4 patients (0.7%), including 4 who presented with microscopic hematuria. If only ultrasound or IVP had been performed 4 of these cases would have been missed. Of 982 patients presenting with microscopic hematuria 51 had cance r. Bladder cancer was found in 7 patients younger than 40 years. Conclusions: Our findings suggest that cystoscopy cannot be safely avoided even in younger patients with microscopic hematuria. Only a combination of ultrasound and NP detected all upper tract tumors.