69 Is CT Urogram Screening Necessary in All Patients with Visible Haematuria in Both the Immediate and Short-Term Follow-Up Period?

Abstract

Abstract Introduction A standardised specific investigation protocol for visible haematuria (VH) screening remains a debate. A recent regional audit highlighted our department as an outlier for the high useage of CT urogram (CTU). We sought to determine the incidence of upper tract cancer (UTC) in a VH cohort, exploring the benefit of routine CTU versus the possibility of developing a selective patient-centred approach. Method Retrospective case-note review of all 2-week-wait patients referred for VH from May-October 2018. Data was analysed to describe the incidence of bladder transitional cell carcinoma (TCC), upper tract transitional cell carcinoma (UTTCC) and renal cell carcinoma (RCC); the detection rate of CTU and the missed rate of UTC over the following four years. Results 437 patients (334 men, 103 women; age range 21-95 years, median age 71 years; 35% smokers, 45% non-smokers, 18% smoking status unknown) underwent VH screening with a cancer detection rate comparable to previous literature (18% TCC, 1.4% RCC, 1% UTTCC). 73% (n = 321) underwent CTU, 52% (n = 229) underwent CTU and ultrasound (USS). USS missed one RCC subsequently detected by CTU. 72.7% and 63.6% of those diagnosed with UTC (age range 57- 86, mean age 71 years) were male or smokers, respectively. 43% (n = 189) received further upper tract imaging during the subsequent four years, with one further RCC detected. Conclusions The additional detection rate of CTU and subsequent development of UTC was minimal within our cohort suggesting the use of CTU in VH screening could be selective rather than routine.