Complete Hematuria Evaluation Occurs in Just 1 in 6 Patients

Men at high-risk of bladder cancer were the most likely to be referred to urologists.

Bladder cancer risk factors (age, tobacco use, and high-risk occupation) appeared to influence whether men, but not women, were referred to urology.
Bladder cancer risk factors (age, tobacco use, and high-risk occupation) appeared to influence whether men, but not women, were referred to urology.

NEW ORLEANS – African-American and female patients tend to be diagnosed with bladder cancer at higher stages and have worse survival possibly due in part to delayed diagnosis of hematuria. Researchers presenting findings at the 2015 American Urological Association annual meeting, however, found no statistically significant associations between race, gender, or number of bladder cancer risk factors and the likelihood of a complete hematuria evaluation.

Investigators led by Jacob Ark, MD, of Vanderbilt University Medical Center in Nashville, studied hematuria evaluation in 1,412 patients (60% African American, 64% female, median age 59 years) from the Southern Community Cohort Study of 85,000 participants. None of the patients had pre-existing diagnoses that caused hematuria. An evaluation was considered complete if both abdomino-pelvic imaging and cystoscopy were performed within 180 days of hematuria diagnosis.  

Imaging was performed in roughly half of cases (44%), and cystoscopy in a fifth (20%); overall, 35% saw a urologist, and nearly 60% of those had a procedure. Hematuria evaluation was considered complete in just 18% of cases.

The researchers highlighted that the number of bladder cancer risk factors (age, tobacco use, and high-risk occupation) appeared to influence whether men, but not women, were referred to urology. 

The researchers also controlled for socioeconomic factors—income, education, marital status— that may underlie these differences, which may attenuate race and gender disparities. The inferior bladder cancer survival in African Americans and women may not be due to race or gender differences in hematuria evaluation, Dr. Ark concluded.

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