title: Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer.
abstract: OBJECTIVE
  Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic hematuria the risk of having bladder cancer can be predicted with high accuracy. Toward this end, we analyzed risk factors in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.
  
  
  METHODS
  Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses. The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.
  
  
  RESULTS
  Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7 %) had bladder cancer. Increasing age (OR = 1.03, p < 0.0001), smoking history (OR = 3.72, p < 0.0001), gross hematuria (OR = 1.71, p = 0.002), and positive cytology (OR = 14.71, p < 0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1 % accuracy for predicting the presence of bladder cancer.
  
  
  CONCLUSIONS
  Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.
authors.affiliation: Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY 10065, USA.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Cha
authors.forename: Lenuta-Ancuta
authors.initials: LA
authors.lastname: Tirsar
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Joerg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Christine
authors.initials: C
authors.lastname: Mian
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Schmitz-Dräger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult