Optimizing Upper-Tract Imaging for Non-Visible Haematuria

Michael K.G.F.T.a· Ravindranath N.a· Michael S.b· German A.a· Riley T.a· Calleary J.G.a· Bourdoumis A.a· Surange R.a

Author affiliations

aDepartment of Urology, Rochdale Infirmary, Northern Care Alliance NHS Foundation Trust, Greater Manchester, United Kingdom
bWythenshawe Hospital, Manchester University NHS Foundation Trust, Greater Manchester, United Kingdom

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Article / Publication Details

First-Page Preview

Abstract of Research Article

Received: May 10, 2022
Accepted: June 05, 2022
Published online: August 30, 2022

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 3

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: https://www.karger.com/UIN

Abstract

Introduction: Non-visible haematuria (NVH) is associated with a small risk of upper-tract urothelial carcinoma (UTUC), though there is little consensus on its investigation, particularly with regard to upper-tract imaging. This study aimed to determine whether the presentation of UTUC can guide investigation of NVH in patients under 60 years old. Methods: All patients investigated at our one-stop haematuria clinics under a cancer pathway were reviewed during a 5-year period, with all patients undergoing cystoscopy and upper-tract imaging. Retrospective analysis of all UTUC cases from our urological cancer multidisciplinary team meeting database over a 10-year period was also undertaken. Results: 2,129 patients with a median age of 67 years underwent urgent investigation for haematuria between March 2015 and February 2020. 449 cases presented with NVH, of whom 124 (27.6%) were under 60. Out of 21 cases of UTUC, only 2 presented with NVH; both were over the age of 60 years. Factors that independently predicted diagnosis with urinary-tract malignancy were age ≥60 (OR 3.70, p < 0.001), visible haematuria (OR 2.50, p = 0.006), and suspicious cystoscopic findings (OR 58.06, p < 0.001). Review of all 119 UTUC cases over 10 years found 6 cases (5.0%) presenting with NVH, with one (0.8%) also presenting under 60 years. Conclusion: Diagnosis with UTUC is rare in patients presenting with NVH under the age of 60 years. Routine use of CTU in this low-risk group is best avoided, with ultrasonography constituting a safer first-line upper-tract imaging modality. Guidelines that risk-stratify NVH patients may be effective in reducing unnecessary investigations.

© 2022 S. Karger AG, Basel

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First-Page Preview

Abstract of Research Article

Received: May 10, 2022
Accepted: June 05, 2022
Published online: August 30, 2022

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 3

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: https://www.karger.com/UIN

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