Undiagnosed macroscopic haematuria revisited: a follow-up of 146 patients

Objective To further investigate a group of patients with macroscopic haema turia who had no abnormalities on upper tract imaging and cystoscopy, to de termine the appropriate follow up. Patients and methods The hospital notes of patients who presented with fran k haematuria between 1990 and 1998 and had no abnormality on cystoscopy and /or upper tract imaging were reviewed, with particular note made of any fur ther bleeding or any other further urological problems. Those with <2 years of follow-up in the hospital notes were investigated by telephone or via t heir general practitioner to ensure that all patients had at least 2 years of follow-up after the initial investigation. Results Of the 146 patients in the study, 98 were alive and had no more ble eding after the initial investigation. None of them were found to have rena l or urothelial tumours during the follow-up. Thirty-three patients had rec urrent episodes of bleeding after the initial investigation: 26 of these ha d repeat investigations and one was found to have a renal pelvic transition al cell carcinoma on repeat intravenous urography. One patient in this subg roup had died from a subarachnoid haemorrhage: 15 other patients had died, 13 of non-urological causes and two of unknown causes. Conclusions Of 146 patients with undiagnosed macroscopic haematuria, only o ne had a missed tumour and this was detected on further investigation for r ecurrent bleeding. These results confirm that repeat cystoscopy and upper t ract imaging is only warranted in patients who have recurrent bleeding afte r initial investigation.