The diagnostic value of macroscopic haematuria for the diagnosis of urological cancer in general practice.
BACKGROUND
The diagnostic value and the impact of some signs and symptoms in most diseases in primary care have only been studied incompletely.


OBJECTIVE
To assess the diagnostic value of macroscopic haematuria for the idagnosis of urological cancer (bladder, kidney) in a general practice setting, as well the influence of age, sex, and some additional signs and symptoms.


METHODS
Diagnostic study.


METHODS
The study was performed in a sentinel station network of general practices in Belgium, covering almost 1% of the population.


METHODS
All patients attending their general practitioner and complaining of haematuria during 1993 and 1994 were included for the prospective part of the study. Every patient diagnosed with a urological cancer in this period was registered for the retrospective part.


METHODS
Mean outcome measures of sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were used to assess diagnostic value.


RESULTS
Within the registration year 1993-1994, patient-doctor encounters, related to 83,890 patient-years, were registered. The positive predictive value (PPV) for urological cancer was 10.3% (95% CI = 7.6% to 13.7%). Sensitivity was 59.5% (95% CI = 50.4% to 60.1%). The PPV of patients aged over 60 years was 22.1% (95% CI = 15.8% to 30.1%) for men and 8.3% (95% CI = 3.4% to 17.9%) for women. In the age group 40 to 59 years, the PPV was 3.6% (95% CI = 0.6% to 13.4%) for men and 6.4% (95% CI = 1.7% to 18.6%) for women. In the prospective part of the study, no urological cancer was found in the age group under 40 years.


CONCLUSIONS
Men older than 60 years of age with macroscopic haematuria have a high positive predictive value for urological cancer. In these patients, a thorough investigation is indicated. In patients over 40 years of age of either sex, referral or watchful waiting can be justified.
Bruyninckx
Rudi
R
Department of General Practice, ACHG Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium. rudi.bruyninckx@skynet.be
Buntinx
Frank
F
Aertgeerts
Bert
B
Van Casteren
Viviane
V
D000328:Adult; D005194:Family Practice; D005260:Female; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014571:Urologic Neoplasms / Q000150:complications* / Q000175:diagnosis