title: Are patients with hematuria appropriately referred to Urology? A multi-institutional questionnaire based survey.
abstract: BACKGROUND
  Hematuria is a common finding that may be a sign of serious underlying urologic disease. Thus, the AUA guidelines (written in conjunction with the American Academy of Family Practice) recommend urologic evaluation for patients with both microscopic and gross hematuria. We sought to evaluate practice patterns of the evaluation of hematuria by primary care physicians (PCPs) in two locations in the United States.
  
  
  METHODS
  Anonymous questionnaires regarding use of urinalysis (UA) and evaluation of hematuria were mailed to 586 PCPs in Miami, Florida and 1,915 in Dallas, Texas. Surveys were mailed to physicians who identified themselves as practitioners of internal medicine, family practice, primary care, or obstetrics and gynecology.
  
  
  RESULTS
  Surveys were completed by 788 PCPs including 270 (46%) and 518 (26%) PCPs in Miami and Dallas, respectively. Screening UAs were obtained on all patients by 77% and 64%, of physicians in Miami and Dallas, respectively. In both Miami and Dallas, only 36% of PCPs reported referring patients with microscopic hematuria to an urologist. In patients with gross hematuria, referral rates were 77% and 69% in Miami and Dallas, respectively.
  
  
  CONCLUSIONS
  While many PCPs use UA in many of their patients routinely, few PCPs automatically refer their patients with microscopic hematuria to urology and not all patients with gross hematuria are referred. Further investigations regarding why and when patients are referred to urology is warranted. Increasing awareness of the complete and timely evaluation of hematuria may be beneficial in preventing a delay in bladder cancer.
authors.affiliation: Department of Urology, University of Miami, Miller School of Medicine, Miami, FL 33136, USA. alan.nieder@columbia.edu
authors.forename: Alan M
authors.initials: AM
authors.lastname: Nieder
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Nuss
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Langston
authors.forename: Sachin
authors.initials: S
authors.lastname: Vyas
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D006417:Hematuria / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D058007:Physicians, Primary Care; D010865:Pilot Projects; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*; D014572:Urology