A retrospective cohort, identifying patients who underwent cystoscopy for investigation of hematuria during a 12 month period was analyzed. Exclusion criteria included age < 18 years, history of bladder/urinary tract/renal cancer and cystoscopy for indications other than hematuria. Primary outcome measures were:
1) Time from general practitioner (GP) referral to urology consultation
2) Time from urology consultation to cystoscopy.
3) Receipt of investigations in the 180 days prior to cystoscopy.
Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes.
Over the study period, 308 eligible cases (228 males, 80 females) were identified. 196 (64%) patients were referred from the general practice setting. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time until urology consultation was 65 days for women and 33.5 days for men (P = 0.015). However, the observed difference between males and females was no longer statistically significant on multivariable regression analysis, and the only independent predictors of a shorter interval were macroscopic hematuria and suspicious findings on imaging. No gender difference was noted in regards to the investigations that hematuria triggered.
Gender was not shown to be a significant predictor of delayed hematuria assessment or receipt of recent investigations. Patients with macroscopic hematuria are were more likely to experience a faster review by urology physicians. Younger patients and those not on anticoagulation received fewer investigations. The authors conclude that additional education for physicians is required to ensure that patients with hematuria are evaluated appropriately.
Presented by: Marlon Perera
Affiliation: Royal Brisbane Hospital, Herston, Australia
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal