title: Microscopic haematuria at time of diagnosis is associated with lower disease stage in patients with newly diagnosed bladder cancer.
abstract: OBJECTIVE
  To determine whether the severity of haematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer.
  
  
  METHODS
  We conducted a multi-institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of haematuria, demographic information, clinical and social history, imaging, and pathology. The association of haematuria severity with incident tumour stage and grade was evaluated using logistic regression.
  
  
  RESULTS
  Patients diagnosed with bladder cancer presented with gross haematuria (GH; 1 083, 78.3%), microscopic haematuria (MH; 189, 13.7%) or without haematuria (112, 8.1%). High-grade disease was found in 64% and 57.1% of patients presenting with GH and MH, respectively, and severity of haematuria was not associated with higher grade disease. Stage of disease at diagnosis for patients presenting with MH was Ta/carcinoma in situ (CIS) in 68.8%, T1 in 19.6%, and ≥T2 in 11.6%. Stage of disease at diagnosis for patients presenting with GH was Ta/CIS in 55.9%, T1 in 19.6%, and ≥T2 in 17.9%. On multivariate analyses, GH was independently associated with ≥T2 disease at diagnosis (odds ratio 1.69, 95% confidence interval 1.05-2.71, P = 0.03).
  
  
  CONCLUSIONS
  Among patients with newly diagnosed bladder cancer, presentation with GH is associated with a more advanced pathological stage. Earlier detection of disease, before development of GH, could influence survival in patients with bladder cancer. Type of haematuria at presentation does not impact grade of disease.
authors.affiliation: Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ramirez
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.affiliation: Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Harrow
authors.affiliation: Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Dobbs
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Kucherov
authors.affiliation: UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Mueller
authors.affiliation: UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Necole
authors.initials: N
authors.lastname: Streeper
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Uhlman
authors.affiliation: UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Messing
authors.affiliation: Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000473:pathology*
keywords: bladder cancer; gross haematuria; microscopic haematuria