Visible and non visible haematuria

Published Date: 19th July 2016

Publication Authors: McCabe JE

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Introduction & Objectives

In the UK investigation of patients presenting with any form of haematuria is now accepted practice and patients are often referred to be seen urgently within 2 weeks, with financial penalties imposed if these targets are not met. We set out to ascertain the proportion of patients presenting with either visible or non visible haematuria to our service, and the rates of detection of malignancy in each group.

Material & Methods 

We analysed data from 1089 consecutive patients referred with haematuria over a 21 month period. Of these 594 (54.6%) were male, and 575 (52.8%) described visible haematuria. Patients' ages ranged from 16-95 years, (mean 59.3 SD 15.9). The patients underwent history taking and physical examination then ultrasound imaging of the urinary tract and plain radiography. A flexible cystoscopy was then performed. In patients with visible haematuria an intravenous urogram was arranged.

Results

45.2% of patients presented with microscopic or dipstick haematuria, 277 female (56%) 215 male (44%). In this group 22 urological malignancies were detected (4.4% incidence). 19 cases of Transitional cell carcinoma (TCC) of the bladder, 2 renal cell carcinomas and 1 ureteric TCC. In the visible haematuria group (52.8% of population), 367 patients were male (64%), and 208 female. 109 cases of malignancy were detected (19%). 99 were TCC of the bladder, 6 RCC and 4 ureteric TCC. Detection of malignancy in both groups increased with age, irrespective of sex. The overall malignancy rate in visible haematuria was 19%, and 4.4% in microscopic or dipstick haematuria. The overall rate of malignancy for all referrals was 12%.

Conclusions

Our data corresponds with other the recent series reporting the rates of referral of both visible and non visible haematuria and the rates of detection of malignancy in both populations. Knowledge of the likelihood of detecting significant disease in these well defined populations can aid planning and provision of services in the future.

Lunt CR; McCabe JE et al. (2012).  What are the incidences of malignancy in patients referred with visible and non visible haematuria? . European Urology Supplements. 11 (1), e336. 

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