MP37-16 UROLOGIST USE OF CYSTOSCOPY FOR PATIENTS PRESENTING WITH HEMATURIA

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2016MP37-16 UROLOGIST USE OF CYSTOSCOPY FOR PATIENTS PRESENTING WITH HEMATURIA Samuel David, Datta Patil, Mehrdad Alemozaffar, Muta Issa, Viraj Master, and Christopher Filson Samuel DavidSamuel David More articles by this author , Datta PatilDatta Patil More articles by this author , Mehrdad AlemozaffarMehrdad Alemozaffar More articles by this author , Muta IssaMuta Issa More articles by this author , Viraj MasterViraj Master More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1693AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In order to rule out a diagnosis of bladder cancer, performance of cystoscopy is an integral component of any guideline-congruent evaluation of a patient presenting with hematuria. Prior studies at a population-level were restricted to select populations (e.g., Medicare-eligible patients) or individual institutions. We used a population-representative survey to evaluate factors associated with use of cystoscopy among patients presenting to urologists with hematuria in the United States. METHODS Using the Center for Disease Control and Prevention National Ambulatory Medical Care Survey (2006-2010, 2012), we identified visits to urologists that resulted in a hematuria diagnosis, based on ICD-9-DM diagnosis codes 599.70, 599.71, or 599.72. After excluding visits with a urinary tract infection (UTI) diagnosis, we generated population-level estimates of cystoscopy use across the United States. Bivariate statistics and multivariable logistic regression were performed to evaluate the relationship between available patient (e.g., age, sex, tobacco use), provider (e.g., specialty, type of degree), and practice setting factors (e.g., region) and use of cystoscopy. Results were considered reliable if based on ≥30 raw observations or if standard errors were < 30% of point estimates. RESULTS Among an estimated 121 million patient visits to urologists, we identified >8.6 million encounters (95% CI 7.2-10.1 million) resulting in a hematuria diagnosis (in absence of UTI). Cystoscopy was performed or ordered after 35.9% (95% CI 31.6-40.4%) of these visits. Use of cystoscopy was more common among older patients (odds ratio (OR) 1.15 per 10 years of age, 95% CI 1.03-1.29) and current smokers (50.9% vs 33.1% non-smokers, OR 2.00, 95% CI 1.15-3.50) (Figure). Use of cystoscopy did not vary based on patient sex (39.9% female vs. 33.4% male, OR 1.40, 95% CI 0.89-2.20, p=0.14). CONCLUSIONS Despite guidelines emphasizing the importance of cystoscopy in the workup of hematuria, just over one-third of patients diagnosed with hematuria by urologists undergo this procedure. Although increased use of cystoscopy for smokers and older patients is encouraging, efforts should focus on increasing adherence to contemporary practice guidelines. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e503 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Samuel David More articles by this author Datta Patil More articles by this author Mehrdad Alemozaffar More articles by this author Muta Issa More articles by this author Viraj Master More articles by this author Christopher Filson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...