“Therefore, all cases of visible hematuria require full standard investigations,” the authors advise.
Dr. Said Fadel Mishriki and colleagues also note that there is uncertainty about the cause when no pathology is found on work-up, and the followup of patients with recurrent visible hematuria is unclear.
They therefore prospectively collected data on 1804 patients with visible hematuria seen at their teaching hospital between 1999 and 2007. All patients underwent standard evaluation with renal ultrasound, excretory urography or CT urogram, cystoscopy and urine cytology.
No pathology was detected in 53.5% of the cases. Malignancy was diagnosed in 21.4% of patients, while other causes included enlarged bleeding prostate, infection, stones, and ureteral stricture.
Median follow-up was 6.6 years. Visible hematuria persisted in 32 patients but none of them was subsequently found to have a malignancy.
Among 69 patients with recurrent hematuria, 35 were found to have significant urologic pathology – including 12 (17.4%) with malignancies – while a diagnosis was still not made in 34 patients.
Based on these findings, “A patient cleared by initial investigations with no VH (visible hematuria) recurrence and no urological malignancy diagnosed can be safely discharged from followup,” Dr. Mishriki and colleagues conclude.
“However,” they caution, “after discharge it should be emphasized that in the event of VH recurrence, regardless of time lapse, it is imperative that urgent referral should be made for further expeditious investigations.”