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Updated: Sep 19, 2025
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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
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Decision Curve Analysis-Based Risk-Adaptive Strategy for Individualizing Cystoscopy Decisions in Patients With
Cagri Akpinar1, Samet Erkartal2, Turker Soydas2
1Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Summary
A new strategy using decision curve analysis (DCA) helps identify patients with microscopic hematuria (MH) who need cystoscopy, reducing unnecessary procedures and improving bladder cancer detection. This risk-adapted approach aids clinical decisions.
Area of Science:
- Urology
- Oncology
- Medical Decision Making
Background:
- Microscopic hematuria (MH) evaluation often involves cystoscopy.
- Identifying patients who benefit most from cystoscopy is crucial to avoid unnecessary procedures.
Purpose of the Study:
- To develop a risk-adapted strategy using decision curve analysis (DCA) for patients with primary microscopic hematuria (MH).
- To aid clinical decision-making and reduce unnecessary cystoscopies.
Main Methods:
- Prospective data from 846 patients with MH undergoing cystoscopy were analyzed.
- Univariate and multivariate analyses identified risk factors for bladder tumors.
- DCA was employed to compare the net benefits of different risk-adapted strategies.
Main Results:
- Bladder tumors were detected in 7.8% of patients.
- Risk factors for tumors included smoking status, pack-years, and advanced age.
- DCA identified optimal strategies based on smoking history and lower urinary tract symptoms (LUTS).
Conclusions:
- DCA-based risk-adapted strategies effectively guide clinical decisions for MH patients.
- These strategies help reduce unnecessary cystoscopies while maintaining diagnostic accuracy.
- The approach supports informed patient and clinician choices regarding cystoscopy.
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