Painless Visible Haematuria in Adults: An Algorithmic Approach Guiding Management

Area of Science:

• Urology
• Diagnostic Imaging
• Oncology

Background:

• Visible haematuria can indicate serious conditions like malignancy, necessitating comprehensive diagnostic evaluation.
• Current diagnostic approaches involve clinical examination, cystoscopy, and urinary tract imaging.

Purpose of the Study:

• To present an evidence-based, consensus-driven decision support tool for imaging adult patients with unexplained, painless visible haematuria.
• To stratify patients into high or low risk for renal and urologic malignancies to guide imaging modality selection.

Main Methods:

• Development of an algorithmic flow chart based on a literature review and international expert guidelines.
• Integration into the Diagnostic Imaging Pathways (DIP) online clinical decision-making tool.
• Risk stratification based on patient factors and potential for malignancy.

Main Results:

• Recommends ultrasound for initial assessment in low-risk, radiation-sensitive patients, and young men (<40 years).
• CT urography (CTU) is advised for high-risk patients due to its sensitivity and specificity for urothelial malignancy.
• MR urography (MRU) is suggested for pediatric, pregnant, or renally impaired patients, offering radiation-free imaging.

Conclusions:

• Cystoscopy remains the gold standard for detecting lower urinary tract urothelial tumors.
• Consensus-based recommendations are crucial for standardizing haematuria management in the absence of comparative outcome studies.
• The decision support tool aims to reduce variability in diagnostic imaging for painless visible haematuria.