Non-Oral Poster 28

Abstract

OBJECTIVES: To evaluate the utility and cost effectiveness of cystoscopy to detect urothelial carcinoma in patients with pelvic organ prolapse and microscopic hematuria. MATERIALS AND METHODS: A retrospective review was performed on 151 patients presenting to a single outpatient urogynecologic centre with pelvic organ prolapse and asymptomatic microscopic hematuria between 2007 and 2008. Pelvic organ prolapse was diagnosed by physical exam and quantified using the pelvic organ prolapse quantification system (POPQ). Microscopic hematuria was defined as >/ = 3 rbcs per high power field on urinalysis. All patients included in the study underwent cystoscopy as part of the routine workup for hematuria. Patients were excluded if they had gross hematuria or a urinary tract infection diagnosed by urine culture. RESULTS: 151 patients were identified as having asymptomatic microscopic hematuria, pelvic organ prolapse and had undergone cystoscopy. Mean age was 63.3 (range 38 to 86), mean BMI was 28.2 (range 19.1 to 42.8) and mean parity was 2 (range 0 to 8). Only 12 (8%) patients were found to have positive findings on cystoscopy while 139 (92%) had negative findings. Positive findings included polyps, diverticulum, erythema and interstitial cystitis. No patients were identified as having urothelial carcinoma. Eighty-three patients had urine cytology in addition to cystoscopy. Nine (11%) of these patients had abnormal findings on urine cytology. Eight patients were found to have atypia and one patient was found to have dysplasia. Of note, none of these patients had positive findings on cystoscopy. A total of $38,900 was spent on cystoscopy at a cost of $258 per cystoscopy. CONCLUSION: The evaluation of hematuria costs the United States $520 million to $1.09 billion a year. The National Cancer Institute quotes a 4.8% incidence of bladder cancer identified in patients undergoing cystoscopy for microscopic hematuria. However, there is controversy over the utility of cystoscopy in the workup of women with microscopic hematuria as some studies report the prevalence of bladder cancer in this cohort as less than 1%. In our study no patients were identified as having bladder cancer after cystoscopy. The use of cystoscopy for routine workup of these patients cost a total of $38,900 without yielding a single diagnosis of bladder cancer. Our study does not support the routine use of cystoscopy in the workup of microscopic hematuria in women with pelvic organ prolapse. A larger cost-benefit analysis should be performed in this patient population.