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Galtung KF, Lauritzen PM, Sandbæk G, Bay D, Baco E, Rud E. Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria. Scand J Urol 2024; 59:147-155. [PMID: 39268780 DOI: 10.2340/sju.v59.40679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Painless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort. MATERIAL AND METHODS "A Prospective Trial for Examining Haematuria using Computed Tomography" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard. RESULTS In 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.
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Affiliation(s)
- Kristina Flor Galtung
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Peter Mæhre Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Bay
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Eduard Baco
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Li L, Liu K, Ma X, Wu Y, Wang C, Wang Y. Primary exophytic urothelial carcinoma of the bladder: A case report. Medicine (Baltimore) 2024; 103:e39187. [PMID: 39121279 PMCID: PMC11315520 DOI: 10.1097/md.0000000000039187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/16/2024] [Indexed: 08/11/2024] Open
Abstract
RATIONALE Bladder urothelial carcinoma (UC) is a common urinary system tumor that is generally diagnosed by cystoscopy combined with pathological biopsy. However, complete exophytic UC of the bladder is very rare and difficult to diagnose. Early diagnosis and accurate identification of such tumors, followed by aggressive surgical treatment, is essential for the management of these patients. PATIENT CONCERNS An 84-year-old man was admitted to the hospital with dysuria, a poor diet, and significant weight loss. DIAGNOSIS Pelvic computed tomography and magnetic resonance imaging revealed an exteriophytic round mass on the right lateral wall of the bladder. Cystoscopy revealed a necrotic mass on the right lateral wall of the bladder cavity, and no tumor cells were found following the biopsy. The tumor was removed via partial cystectomy, and the pathological result indicated high-grade muscle-invasive UC. INTERVENTIONS The patient refused radical cystectomy and underwent laparoscopic partial cystectomy plus pelvic lymph node dissection followed by cisplatin plus gemcitabine chemotherapy. OUTCOMES The patient's mental state and appetite were significantly improved after the urinary tube was removed 1 week after surgery. His general state was significantly improved after 1 month of follow-up but died of acute cerebral infarction 3 months after surgery. LESSONS UC of the bladder may grow completely out of the bladder without symptoms such as gross hematuria; thus, early diagnosis is difficult. For high-risk individuals, regular imaging tests may help to detect tumors early. Partial cystectomy is a reliable surgical modality for bladder preservation in such patients.
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Affiliation(s)
- Liangliang Li
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Kun Liu
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Xueping Ma
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Yameng Wu
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Changxi Wang
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Yangang Wang
- Department of Urology, The Fuyang Hospital of Anhui Medical University, Fuyang, China
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Abuhasanein S, Chaves V, Mohsen AM, Al‐Haddad J, Sunila M, Ströck V, Jerlström T, Liedberg F, Swärd J, Gårdmark T, Jahnson S, Kjölhede H. Diagnostic value of repeated comprehensive investigation with CT urography and cystoscopy for recurrent macroscopic haematuria. BJUI COMPASS 2024; 5:253-260. [PMID: 38371208 PMCID: PMC10869664 DOI: 10.1002/bco2.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria. Methods All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed. Results A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria. Conclusion In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.
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Affiliation(s)
- Suleiman Abuhasanein
- Department of Urology, Institute of Clinical Science, Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
- Department of Surgery, Urology SectionNU Hospital GroupUddevallaSweden
| | - Vanessa Chaves
- Department of Surgery, Urology SectionNU Hospital GroupUddevallaSweden
| | | | - Jasmine Al‐Haddad
- Department of Surgery, Urology SectionNU Hospital GroupUddevallaSweden
| | - Merete Sunila
- Department of Surgery, Urology SectionNU Hospital GroupUddevallaSweden
| | - Viveka Ströck
- Department of Urology, Institute of Clinical Science, Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
- Department of UrologySahlgrenska University HospitalGöteborgRegion Västra GötalandSweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine, and HealthÖrebro UniversityÖrebroSweden
| | - Fredrik Liedberg
- Department of Urology Skåne University Hospital, Malmö, Sweden and Institution of Translational MedicineLund UniversityMalmöSweden
| | - Jesper Swärd
- Department of Urology, Institute of Clinical Science, Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstituteStockholmSweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of UrologyLinköping UniversityLinköpingSweden
| | - Henrik Kjölhede
- Department of Urology, Institute of Clinical Science, Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
- Department of UrologySahlgrenska University HospitalGöteborgRegion Västra GötalandSweden
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4
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Galtung KF, Lauritzen PM, Sandbæk G, Bay D, Ponzi E, Baco E, Cowan NC, Naas AM, Rud E. Computed tomography for visible haematuria - a single nephrographic phase is sufficient for detecting renal cell carcinoma. Scand J Urol 2024; 59:10-18. [PMID: 38226799 DOI: 10.2340/sju.v59.18467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria. MATERIALS & METHODS 'A Prospective Trial for Examining Hematuria using Computed Tomography' (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics. RESULTS A total of 308 patients (median age, 68 years [interquartile range 53-77, range 18-96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15-25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79). CONCLUSION A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.
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Affiliation(s)
- Kristina Flor Galtung
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Peter Mæhre Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Dag Bay
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Erica Ponzi
- Department of Research Support for Clinical Trials, Clinical Trial Unit, Oslo University Hospital, Oslo, Norway; Oslo Center for Biostatistics and Epidemiology (OCBE), Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Eduard Baco
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | | | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Compérat E, Amin MB, Cathomas R, Choudhury A, De Santis M, Kamat A, Stenzl A, Thoeny HC, Witjes JA. Current best practice for bladder cancer: a narrative review of diagnostics and treatments. Lancet 2022; 400:1712-1721. [PMID: 36174585 DOI: 10.1016/s0140-6736(22)01188-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
This Seminar presents the current best practice for the diagnosis and management of bladder cancer. The scope of this Seminar ranges from current challenges in pathology, such as the evolving histological and molecular classification of disease, to advances in personalised medicine and novel imaging approaches. We discuss the current role of radiotherapy, surgical management of non-muscle-invasive and muscle-invasive disease, highlight the challenges of treatment of metastatic bladder cancer, and discuss the latest developments in systemic therapy. This Seminar is intended to provide physicians with knowledge of current issues in bladder cancer.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, Tenon Hospital, Sorbonne University, Paris, France; Department of Pathology, Medical University of Vienna, Vienna, Austria.
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN, USA
| | - Richard Cathomas
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Ashish Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnulf Stenzl
- Department of Urology, University Hospital, Tübingen, Germany
| | - Harriet C Thoeny
- Department of Radiology, HFR Fribourg-Hôpital Cantonal, University of Fribourg, Villars-sur-Glâne, Switzerland; Department of Urology, Inselspital University Hospital, Bern, Switzerland
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Rai BP, Luis Dominguez Escrig J, Vale L, Kuusk T, Capoun O, Soukup V, Bruins HM, Yuan Y, Violette PD, Santesso N, van Rhijn BWG, Hugh Mostafid A, Imran Omar M. Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria. Eur Urol 2022; 82:182-192. [PMID: 35393159 DOI: 10.1016/j.eururo.2022.03.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/12/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022]
Abstract
CONTEXT The current impact of haematuria investigations on health care organisations is significant. There is currently no consensus on how to investigate patients with haematuria. OBJECTIVE To evaluate the incidence of bladder cancer, upper tract urothelial carcinoma (UTUC), and renal cell carcinoma (RCC) among patients undergoing investigation for haematuria and identify any risk factors for bladder cancer, UTUC, and RCC (BUR). EVIDENCE ACQUISITION Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov were searched for all relevant publications from January 1, 2000 to June 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Prospective, retrospective, and cross-sectional studies with a minimum population of 50 patients with haematuria were considered for the review. EVIDENCE SYNTHESIS A total of 44 studies were included. The total number of participants was 229701. The pooled incidence rate for urothelial bladder cancer was 17% (95% confidence interval [CI] 14-20%) for visible haematuria (VH) and 3.3% (95% CI 2.45-4.3%) for nonvisible haematuria (NVH). The pooled incidence rate for RCC was 2% (95% CI 1-2%) for VH and 0.58% (95% CI 0.42-0.77%) for NVH. The pooled incidence rate for UTUC was 0.75% (95% CI 0.4-1.2%) for VH and 0.17% (95% CI 0.081-0.299%) for NVH. On sensitivity analysis, the proportions of males (risk ratio [RR] 1.14, 95% CI 1.10-1.17 for VH; 1.54, 95% CI 1.34-1.78 for NVH; p < 0.00001; moderate certainty evidence) and individuals with a smoking history (RR 1.41, 95% CI 1.24-1.61 for VH; 1.53, 95% CI 1.36-1.72 for NVH; p < 0.00001; moderate certainty evidence) appeared to be higher in BUR than in non-BUR groups. CONCLUSIONS Male gender and smoking history are risk factors for BUR cancer in haematuria, with bladder cancer being the commonest cancer. The incidence of RCC and UTUC in NVH is low. The review serves as a reference standard for future policy-making on investigation of haematuria by global organisations. PATIENT SUMMARY Our review shows that male gender and smoking history are risk factors for cancers of the bladder, kidney, and ureter. The review also provides information on the proportion of patients who have cancer when they have blood in their urine (haematuria) and will allow policy-makers to decide on the most appropriate method for investigating haematuria in patients.
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Affiliation(s)
- Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | | | - Luís Vale
- Department of Urology, Centro Hospital Universitário S. João, Porto, University of Porto, Porto, Portugal
| | - Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Otakar Capoun
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Viktor Soukup
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Harman M Bruins
- Department of Urology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Philippe D Violette
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, ON, Canada
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
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7
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Sarier M, Demir M, Emek M, Turgut H. Hematuria frequency and association with abnormal urological findings in medical check-up patients. Niger J Clin Pract 2022; 25:310-314. [PMID: 35295054 DOI: 10.4103/njcp.njcp_1509_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims and Background Hematuria is one of the most common findings in urology. The management of hematuria detected in routine medical check-ups is also important in this respect. The aim of this study was to determine the frequency of hematuria in patients undergoing medical check-ups and evaluate its association with abnormal urological findings in laboratory tests and imaging. Patients and Methods Asymptomatic patients who presented to the check-up clinic between January 1 and December 31, 2020, were included. All patients underwent a complete laboratory workup and total abdominal ultrasound (TAUS). The distribution of hematuria by sex and age and the relationship between hematuria and abnormal urological findings in the laboratory tests and TAUS were calculated. Results The mean age of the 2,077 check-up patients was 45.8 ± 12.8 years. The female to male ratio was 1.07:1, and there was no significant difference in age between the sexes (P = 0.655). Microscopic hematuria was detected in 15.9% of the patients. The frequency of hematuria was 10.8% in men and 20.7% in women (P < 0.001). Men with hematuria were significantly older than men without hematuria (P = 0.033), whereas hematuria was not associated with age in women (P = 0.521). When its relationship between abnormal urological findings was evaluated, hematuria had a sensitivity of 21.70% (95% confidence interval [CI]: 18.84, 24.86) and a specificity of 87.11% (95% CI: 85.23, 88.79). Conclusion The frequency of hematuria in check-up patients was remarkable, at 15.9%. Hematuria in women is more common and unrelated to age, unlike in men. Hematuria had a high specificity but low sensitivity for urological abnormal findings.
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Affiliation(s)
- M Sarier
- Department of Urology, Istinye University, Istanbul; Department of Urology, Medical Park Hospital, Antalya, Turkey
| | - M Demir
- Faculty of Health Sciences, Bilim University, Antalya, Turkey
| | - M Emek
- Department of Public Health, Akdeniz University, Antalya, Turkey
| | - H Turgut
- Faculty of Health Science, Avrasya University, Trabzon, Turkey
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Sancı A, Özkaya MF, Kubilay E, Gokce Mİ, Süer E, Gülpinar O, Baltacı S, Turkolmez K. Individual-risk-score for urinary tract malignancy in patients with microscopic hematuria. Int J Clin Pract 2021; 75:e14662. [PMID: 34322953 DOI: 10.1111/ijcp.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
AIM To determine the patients who can be safely exempted from undergoing unnecessary diagnostic procedures for microscopic hematuria (MH) evaluation by using the developed individual-risk-scoring system. MATERIALS AND METHODS The patients who underwent a complete urological evaluation for MH were identified retrospectively. The risk factors for urinary malignancy which defined in the 2020 American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines were recorded for each patient. Multivariable logistic regression was performed to establish a predictive risk-scoring system. The odds ratios obtained as a result of the logistic regression analysis were scored. RESULTS A total of 1461 patients who had undergone a complete urological evaluation for MH were identified. The urinary malignancy rate was 3.4% (50 of the 1461 patients). According to the odds ratios, age >40 was calculated as 1 point; male gender, 2 points; smoking history, 4 points; presence of occupational risk factor, 1 point; and presence of macroscopic hematuria, 2 points. For the cut-off risk score, 5 points was found to be the most appropriate score according to the sensitivity and specificity levels. The patients with risk scores of 5 points or lower were considered to be in the low-risk group for urinary tract malignancy. CONCLUSION The patients with a risk score of 5 points or above require complete urological evaluation. The results of the present study may reduce the number of patients undergoing unnecessary urological evaluation.
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Affiliation(s)
- Adem Sancı
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | | | - Eralp Kubilay
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | - Mehmet İlker Gokce
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | - Evren Süer
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | - Omer Gülpinar
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | - Sumer Baltacı
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
| | - Kadir Turkolmez
- Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey
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Sancı A, Oktar A, Gokce MI, Süer E, Gülpinar O, Gögüs C, Baltacı S, Turkolmez K. Comparison of Microscopic Hematuria Guidelines as Applied in 1018 Patients With Microscopic Hematuria. Urology 2021; 154:28-32. [PMID: 33971192 DOI: 10.1016/j.urology.2021.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the 2012 American Urological Association (AUA) and 2020 AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) microscopic hematuria (MH) guidelines as applied in 1,018 patients with MH, to confirm of risk groups and to investigate the natural history of patients with MH. MATERIALS AND METHODS Patients who had undergone a complete urological evaluation for MH according to the 2012 AUA MH guidelines were identified retrospectively. All the patients were then classified into low-, intermediate-, or high-risk for urinary tract malignancy according to the updated 2020 AUA/SUFU MH guidelines, for a second evaluation. The results of the first and second evaluations using the previous 2012 AUA and updated 2020 AUA/SUFU MH guidelines, respectively, were then compared. RESULTS A total of 1018 patients with MH were identified. The urinary tract malignancy rate was 3.3% (34 of the 1,018 patients). According to the 2020 AUA/SUFU MH guidelines, there were 218 patients (21.4%) in the low-risk group, 447 patients (43.9%) in the intermediate-risk group, and 353 patients (34.6%) in the high-risk group. All the 34 patients with malignancy were from the intermediate- or high-risk group who require further urological evaluation. There was no patient with newly developed urinary tract malignancy at the median follow-up time of 28 months (12-58). CONCLUSION The use of the updated 2020 AUA/SUFU MH guidelines may reduce the number of diagnostic procedures without compromising the diagnosis of life-threatening malignant lesions.
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Affiliation(s)
- Adem Sancı
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Alkan Oktar
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Mehmet I Gokce
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Evren Süer
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey.
| | - Omer Gülpinar
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Cagatay Gögüs
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Sumer Baltacı
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
| | - Kadir Turkolmez
- Urology department, Ankara University Faculty of Medicine, Altindag, Ankara, Turkey
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10
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Waisbrod S, Natsos A, Wettstein MS, Saba K, Hermanns T, Fankhauser CD, Müller A. Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e218409. [PMID: 33970257 PMCID: PMC8111485 DOI: 10.1001/jamanetworkopen.2021.8409] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Microhematuria (MH) is a common finding that often leads to further evaluation for urinary tract cancers. There is ongoing debate about the extent to which patients with MH should be evaluated for cancer. OBJECTIVE To assess the diagnostic yield for detection of urinary tract cancers, specifically bladder cancer, upper tract urothelial carcinoma (UTUC), and kidney cell carcinoma, among patients evaluated for MH using cystoscopy and computed tomographic (CT) urography. DATA SOURCES MEDLINE, Scopus, and Embase were systematically searched for eligible studies published between January 1, 2009, and December 31, 2019. STUDY SELECTION Original prospective and retrospective studies reporting the prevalence of cancer among patients evaluated for MH were eligible. Two authors independently screened the titles and abstracts to select studies that met the eligibility criteria and reached consensus about which studies to include. Among 5802 records identified, 5802 articles were screened using titles and abstracts. After exclusions, 55 full-text articles were assessed for eligibility, with 39 studies selected for systematic review. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Studies were quantitatively synthesized using a random-intercept logistic regression model. MAIN OUTCOMES AND MEASURES The primary outcome was diagnostic yield, defined as the proportion of patients with a diagnosis of urinary tract cancer (bladder cancer, UTUC, or kidney cell carcinoma) after presentation with MH. Studies were stratified by the percentage of cystoscopy and CT urography use and by high-risk cohorts. The diagnostic yields of CT urography and cystoscopy were calculated for each cancer type. RESULTS A total of 30 studies comprising 24 366 patients evaluated for MH were included in the meta-analysis. The pooled diagnostic yield among all patients was 2.00% (95% CI, 1.30%-3.09%) for bladder cancer, 0.02% (95% CI, 0.0%-0.15%) for UTUC, and 0.18% (95% CI, 0.09%-0.36%) for kidney cell carcinoma. Stratification of studies that used cystoscopy and/or CT urography for 95% or more of the cohort produced diagnostic yields of 2.74% (95% CI, 1.81%-4.12%) for bladder cancer, 0.09% (95% CI, 0.01%-0.75%) for UTUC, and 0.10% (95% CI, 0.04%-0.23%) for kidney cell carcinoma. In high-risk cohorts, the diagnostic yields increased to 4.61% (95% CI, 2.34%-8.90%) for bladder cancer and 0.45% (95% CI, 0.22%-0.95%) for UTUC. CONCLUSIONS AND RELEVANCE This study's findings suggest that, given the low diagnostic yield of CT urography and the associated risks and costs, limiting its use to high-risk patients older than 50 years is warranted. Risk stratification, as recommended by the recent American Urology Association guidelines on MH, may be a better approach to tailor further evaluation.
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Affiliation(s)
- Sharon Waisbrod
- Department of Urology, Spital-Limmattal, Schlieren, Switzerland
| | | | | | - Karim Saba
- Department of Urology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Accuracy of ultrasound vs computed tomography scan for upper urinary tract malignancies and development of a risk-based diagnostic algorithm for haematuria in a UK tertiary centre. Int Urol Nephrol 2020; 53:49-57. [PMID: 32844354 DOI: 10.1007/s11255-020-02615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There is no consensus across guidelines on a diagnostic algorithm for upper urinary tract (UUT) evaluation following presentation with haematuria. Our aim is to compare the diagnostic accuracy of ultrasound (USS) compared to CT-scan for UUT malignancies and also determine the considerations important for a risk-based diagnostic protocol for haematuria. METHODS We reviewed our 'haematuria clinic' database to identify patients who had both USS and CT-scan for UUT evaluation between September 2015 and August 2017, and calculated the diagnostic accuracy of these imaging modalities for histologically confirmed UUT cancers. Furthermore, we identified risk factors in our diagnostic algorithm for haematuria and conducted regression analysis to determine their ability to predict UUT malignancies. RESULTS Overall, 575 patient records were studied. Age range was 21-92 years, M:F was 1.4:1, majority (81.2%) had visible haematuria, and 12 (2.1%) UUT cancers were diagnosed [renal cell carcinoma-1.4%; upper tract urothelial cancer-0.7%]. USS and CT-scan had diagnostic accuracy for UUT cancers of 95.8 and 99.1%, respectively (p < 0.001). Haematuria type was a significant consideration only on univariate analysis, while multivariate binary logistic regression showed that male gender, smoking, occupational exposure, and positive urologic history were the main risk factors associated with UUT malignancies. CONCLUSION USS and CT-scan have comparably high diagnostic accuracy for detecting UUT malignancies. USS may, therefore, be considered as the first-line UUT imaging modality when utilized in a risk-based diagnostic algorithm. Larger, multicentred studies are needed to validate our findings and influence guideline development.
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Sabour S. Diagnostic accuracy of ultrasonography to detect urinary tract malignancies in patients with asymptomatic hematuria: importance of diagnostic added value to avoid misinterpretation. World J Urol 2020; 39:977-978. [PMID: 32328777 DOI: 10.1007/s00345-020-03209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Siamak Sabour
- Department of Clinical Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, 198353-5511, Islamic Republic of Iran.
- Safety Promotions and Injury Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, 198353-5511, Islamic Republic of Iran.
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