Original articleStratifying Risk of Urinary Tract Malignant Tumors in Patients With Asymptomatic Microscopic Hematuria
Section snippets
Patients and Methods
From January 9, 2009, to August 15, 2011, a prospective, observational cohort study was conducted within a large managed care organization (Kaiser Permanente) that provides comprehensive care for members through a capitated health plan. Most health care for members is provided in system-owned medical centers or their affiliated outpatient facilities. A small fraction of emergent and specialty care is obtained from other health care professionals through contractual arrangements or through a
Results
There were 3,222,699 urinalyses performed in 1,117,542 patients in the test cohort regions from January 9, 2009, to October 26, 2010. Of these patients, 456,674 had microscopic hematuria and 389,207 had 2 positive urinalysis results meeting the threshold for evaluation. During this period, 7778 patients were seen by a urologist for evaluation of asymptomatic microhematuria and 4721 underwent cystoscopy. The details of 2630 of those evaluations were entered into the electronic data collection
Discussion
In this prospective cohort study, we found that microscopic hematuria is an unreliable indicator of urothelial or renal malignant tumors. An extremely small proportion of patients with microscopic hematuria are subsequently found to have cancer, confirming our previous retrospective results.12 In fact, most malignant tumors can be identified by a history of gross hematuria, a far more reliable indicator of the need for urologic evaluation and imaging. This finding suggests that a large number
Conclusion
These data suggest that microscopic hematuria is an unreliable indicator of urinary tract malignant tumors. Patients with microscopic hematuria younger than 50 years and with no history of gross hematuria may not benefit from further evaluation and therefore could avoid unnecessary risk from radiation exposure and invasive endoscopy. These findings may be used to simplify referral guidelines for evaluation in asymptomatic patients with microscopic hematuria and reduce the number of unnecessary
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Cited by (132)
Diagnostic yield of upper tract imaging performed for hematuria screening: Results from a national, privately-insured cohort
2024, Urologic Oncology: Seminars and Original InvestigationsEDITORIAL COMMENT
2022, UrologyA 25-year perspective on evaluation and understanding of biomarkers in urologic cancers
2021, Urologic Oncology: Seminars and Original Investigations
For editorial comment, see page 123
Grant Support: This study was funded from internal infrastructure from the Department of Research and Evaluation, Kaiser Permanente Southern California.