Visualizing grades of hematuria for communication enhancement and continuous bladder irrigation guidance

Gross hematuria often requires continuous bladder irrigation (CBI) to prevent clot retention. Decisions to initiate, adjust, or discontinue CBI rely on subjective visual assessment, causing practice variability. This study aimed to develop a consensus-based visual hematuria scale to guide CBI management and improve communication.

Ten simulated hematuria specimens (20%-0.04% hematocrit) were prepared using packed red blood cells and normal saline. Urologists and residents (≥1 year CBI experience) evaluated specimens in person or through photographs. Participants identified threshold specimens for four actions: (1) notifying an urologist, (2) increasing CBI rate, (3) decreasing CBI rate, and (4) stopping CBI. Data were analyzed using mode, interquartile range (IQR), and appropriate exact tests.

Of 150 respondents, 145 met the inclusion criteria (54.5% residents, 45.5% urologists). Modes (IQR) for each action were: Notify - 1 (IQR = 2), Increase rate - 5 (IQR = 2), Decrease rate - 8 (IQR = 2), and Stop - 9 (IQR = 2). Exact agreement ranged from 26.2% to 44.8%, while adjacent agreement (within ± 1 grade) demonstrated strong consensus, ranging from 61.4% to 93.1%. Responses did not differ significantly between urologists and residents. On-site and online responses differed slightly regarding the "increase rate" threshold (P = 0.011).

This multi-center survey identified consensus thresholds for a 4-point visual hematuria grading scale. This scale is intended to serve as a communication aid to standardize the language in CBI management. While this consensus provides a foundation, further studies are needed to validate the proposed grading system in real-world settings and incorporate additional clinical parameters.