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Individual-risk-score for urinary tract malignancy in patients with microscopic hematuria
Adem Sancı1, Mehmet Fatih Özkaya1, Eralp Kubilay1
1Faculty of Medicine, Urology Department, Ankara University, Ankara, Turkey.
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.
Insights
A new risk-scoring system helps identify patients with microscopic hematuria (MH) who do not need further urological evaluation. This system can prevent unnecessary diagnostic procedures for low-risk individuals.
Area of Science:
- Urology
- Diagnostic Procedures
- Risk Assessment
Background:
- Microscopic hematuria (MH) evaluation often involves extensive diagnostic procedures.
- Identifying patients who can safely avoid these procedures is crucial for reducing healthcare costs and patient burden.
Purpose of the Study:
- To develop and validate an individual-risk-scoring system for microscopic hematuria (MH) evaluation.
- To determine which patients can be safely exempted from unnecessary diagnostic procedures.
Main Methods:
- Retrospective analysis of 1461 patients who underwent complete urological evaluation for MH.
- Utilized risk factors for urinary malignancy from the 2020 American Urological Association guidelines.
- Performed multivariable logistic regression to create a predictive risk-scoring system based on odds ratios.
Main Results:
- The overall urinary malignancy rate was 3.4%.
- A risk-scoring system was developed: age >40 (1 point), male gender (2 points), smoking history (4 points), occupational risk (1 point), macroscopic hematuria (2 points).
- A risk score of 5 or lower identified patients in the low-risk group for urinary tract malignancy.
Conclusions:
- Patients with a risk score of 5 or above require complete urological evaluation.
- The developed risk-scoring system has the potential to significantly reduce the number of patients undergoing unnecessary urological evaluations for microscopic hematuria.
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