title: High-risk patients with hematuria are not evaluated according to guideline recommendations.
abstract: BACKGROUND
  To determine whether high-risk patients with hematuria receive evaluation according to guideline recommendations.
  
  
  METHODS
  We recently performed a screening study for bladder cancer using a urine-based tumor marker in 1502 subjects at high risk based on aged > or = 50 years, > or = 10-year smoking history, and/or a 15-year or more environmental exposure. We evaluated use of urinalysis (UA) within 3 years preceding the screening study. Chart review was performed to determine if this subset with microhematuria received any additional evaluation.
  
  
  RESULTS
  Of 1502 study participants, routine urinalysis was performed in 73.2% and 164 (14.9%) subjects had documented hematuria (>3 red blood cells / high-power field) before inclusion. Of these, 42.1% had no further evaluation. Additional testing included repeat urinalysis (36%), urine culture (15.2%), cytology (10.4%), imaging (22.6% overall: 15.9% computed tomography, 4.3% intravenous pyelography; 2.4% magnetic resonance imaging), and cystoscopy (12.8%). Three subjects with microscopic hematuria (2%) were subsequently found to have bladder cancer during the screening study but were not referred for evaluation based on their hematuria. The source of hematuria was unknown in 65%, infection in 22%, benign prostatic enlargement in 10%, and renal stone disease in 4%, but these results are based on incomplete evaluation since only 12.8% underwent cystoscopy.
  
  
  CONCLUSIONS
  Subjects at high risk for bladder cancer based on > or = 10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center at Dallas, TX, USA.
authors.forename: Keren
authors.initials: K
authors.lastname: Elias
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
authors.forename: Richard
authors.initials: R
authors.lastname: Ho
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D003584:Cytological Techniques / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012306:Risk; D012907:Smoking; D013997:Time Factors; D016482:Urinalysis / Q000706:statistics & numerical data*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor