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Is microscopic haematuria a urological emergency?
M A Khan1, G Shaw, A M I Paris
1Department of Urology, Barts and The London NHS Trust, London, UK. Ktasmas@aol.com
BJU International
|August 15, 2002
Summary
Microscopic haematuria in patients often shows no significant pathology. Re-testing with urine microscopy is recommended before referral, as malignant urological conditions are rare.
Area of Science:
- Urology
- Nephrology
- Oncology
Background:
- Microscopic haematuria is a common finding requiring investigation.
- The diagnostic yield of urological pathology in microscopic haematuria is not well-defined.
Purpose of the Study:
- To determine the prevalence of urological pathology in patients with microscopic haematuria.
- To evaluate the effectiveness of current diagnostic protocols for microscopic haematuria.
Main Methods:
- Retrospective and prospective study of 368 patients with microscopic haematuria.
- Investigations included urine analysis, cytology, renal ultrasonography, intravenous urography (IVU), and flexible cystoscopy.
- Prostate specific antigen (PSA) was assayed where appropriate.
Main Results:
- No malignant cells were detected by urine cytology.
- Urological pathology was identified in 39% of patients, with bladder tumors (1.4%) and renal stones (4.1%) being most common.
- Intravenous urography (IVU) and flexible cystoscopy revealed most significant findings.
Conclusions:
- Dipstick-positive microscopic haematuria requires re-assessment by urine microscopy before referral.
- Malignant urological pathology is rare in microscopic haematuria (1.4%), suggesting it should be managed differently from macroscopic haematuria.
- Urgent referral for microscopic haematuria may not be necessary for all patients.