Evaluating hematuria: impact of guideline adherence on urologic cancer diagnosis
Atul B Shinagare1, Stuart G Silverman1, Esteban F Gershanik2
1Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Insights
Physician adherence to 2001 American Urological Association (AUA) guidelines for asymptomatic hematuria was low. However, no cancers were missed in patients with non-adherent evaluations, suggesting urologist evaluation is key.
Area of Science:
- Urology
- Medical Guidelines
- Diagnostic Evaluation
Background:
- Asymptomatic hematuria requires careful evaluation to rule out urologic malignancy.
- The 2001 American Urological Association (AUA) guidelines provide a framework for this evaluation.
- Physician adherence to these guidelines is crucial for timely cancer diagnosis.
Purpose of the Study:
- To assess physician adherence to the 2001 AUA guidelines for evaluating patients with asymptomatic hematuria.
- To determine the impact of guideline adherence on the diagnosis of urologic cancer.
Main Methods:
- Retrospective study of 100 patients with asymptomatic hematuria evaluated at an academic health center.
- Analysis of patient demographics, hematuria type, physician specialty, and diagnostic evaluations performed.
- Multivariate logistic regression to identify predictors of guideline adherence and cancer diagnosis.
Main Results:
- Only 36% of patients received a guideline-adherent evaluation.
- No urologic cancers were diagnosed in the 64 patients with non-adherent evaluations.
- Evaluation by a urologist was the sole significant predictor of guideline adherence.
Conclusions:
- Most physicians did not adhere to the 2001 AUA guidelines for asymptomatic hematuria.
- Non-adherent evaluations did not appear to result in missed urologic cancers, though occult malignancies cannot be ruled out.
- Further research is needed to optimize the evaluation of asymptomatic hematuria.
Purpose:
The purpose of this study was to assess physician adherence to 2001 American Urological Association (AUA) guidelines for evaluating patients with asymptomatic hematuria and its impact on the diagnosis of urologic cancer.
Methods:
In this institutional review board-approved retrospective study of patients with asymptomatic hematuria evaluated in a large academic health center in 2004 (allowing for long-term follow-up), we randomly selected 100 of 1771 patients with asymptomatic hematuria (52 men; mean age 54 years; 58 microscopic, 39 macroscopic, three unknown-type hematuria; median follow-up 89 months, interquartile range 33-97 months). Multivariate logistic regression assessed effects of age, sex, hematuria type, and physician specialty on guideline adherence, the primary outcome. Secondary outcome measures were variability in evaluation among physician specialists, and the proportion of patients developing urologic cancer.
Results:
Only 36 of 100 patients had a guideline-adherent evaluation, of which 5 were diagnosed with urologic cancer (median 1 month, range 0-11). No urologic cancers were diagnosed in 64 patients with nonadherent evaluations. Only evaluation by a urologist significantly predicted guideline adherence (P <.0001). Patients with gross hematuria more often underwent intravenous or computed tomography urography (P = .009); urologist evaluation more often led to intravenous or computed tomography urography (P <.0001), cystoscopy (P <.0001), cytology (P = .009), and guideline-adherent evaluation (P <.0001).
Conclusions:
Although most physicians did not adhere to 2001 AUA guidelines when evaluating patients with asymptomatic hematuria, no urologic cancers were diagnosed in patients without guideline-adherent evaluation, barring the possibility of occult cancers. Evaluation by a urologist was the only predictor of a guideline-adherent evaluation. Future studies are needed to determine the optimal evaluation of patients with asymptomatic hematuria.
Related Concept Videos
01:21Nursing Assessment of the Genitourinary System I: Health History
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:30Urinary Tract Calculi III: Medical Management
01:28Urinary Tract Calculi V: Nursing Management