What are the key papers and

messages in the evaluation of

haematuria?

N. Osman
ST6
Sheffield
 Terminology
Joint consensus statement on initial assessment of
haematuria by BAUS and Renal association 2008
•Visible Haematuria (VH)
•Non visible haematuria (NVH) – symptomatic or
asymptomatic
1) Dipstick +ve (≥1+)
2) Microscopy-chamber count vs sediment count
-variable definition (eg.>3 RBC/HPF)
 NICE referral guideline
1.6.4 Refer people using a suspected cancer pathway referral (for an appointment
within 2 weeks) for bladder cancer if they are:

•aged 45 and over and have:

•unexplained visible haematuria without urinary tract infection or
•visible haematuria that persists or recurs after successful treatment of urinary
tract infection, or

•aged 60 and over and have unexplained non-visible haematuria and either dysuria
or a raised white cell count on a blood test. [new 2015]

1.6.5 Consider non-urgent referral for bladder cancer in people aged 60 and over
with recurrent or persistent unexplained urinary tract infection. [new 2015]
• Aim: to evaluate current diagnostic approach to haematuria and whether a less intensive
approach is possible
• Methods: Prospective study patients attending haematuria clinic 1994-1997
All underwent urinalysis, cytology, US, IVU, Cystoscopy
• Results: Normal evaluation 61%, VH - Cancer in 24%, NVH - Cancer in 9.4%
Bladder cancer was diagnosed in 7 patients <40 yrs, incl. 1 who presented with NVH
Bladder cancer was diagnosed in 9.7% of non smokers
If only US performed – 6 upper tract cancers missed
If only IVU performed – 3 upper tract cancers missed

• Key messages:

1) Cystoscopy cannot be safely excluded in lower risk groups ( eg younger, non smokers, NVH)

2) Both US and IVU are needed in assessment of upper tracts

• Aim: to clarify likelihood of detecting disease, mode of detecting of upper tract cancer and
the role of IVU after normal US
• Methods: Prospective study patients attending haematuria clinic 1998-2003
All underwent US and Cystoscopy+ IVU if abnormality or persistent haematuria
Results: Normal evaluation in >75%, VH - Cancer in 19%, NVH - Cancer in 4.8%
No upper tract tumours in pts <30, no upper tract TCC in pts <50
Most upper tract TCC presented with VH

• Key messages:

1, IVU should be reserved for older pts (>50) with VH or positive repeat
dipstick where first line tests negative
 Suggested reading
• Joint consensus statement on initial
assessment of haematuria by BAUS and
Renal association 2008
• Khadra et al 2000 (Newcastle paper)
• Edwards et al 2006
• NICE guidelines