Outcomes of haematuria referrals: two-year data from a single large university hospital in Denmark

Abstract

Objective: The aim of this study was to review haematuria referrals to a large university hospital in Denmark, based on the previous Danish guidelines for haematuria referral (before January 2016), to evaluate the pattern of referrals and the cancer detection rates and compare these with the current guidelines.Materials and methods: A retrospective study was undertaken of all patients referred from primary care for the evaluation of haematuria from January 2013 to December 2014. All patients underwent cystoscopic examination and upper urinary tract evaluation using computed tomography. Patients' demographics, type of haematuria, presence of urinary symptoms and cancer detection rates were recorded.Results: The study included 1577 patients, with a mean age of 63 years (range 16–96 years). Of these, 56.4% had visible haematuria (VH) and 43.6% were referred for non-visible haematuria (NVH). In total, 228 malignancies were detected (14.5% cancer detection rate). Overall, 11.2% of patients had bladder cancer, 1.8% renal cancer and 0.4% upper tract transitional cell carcinoma. In the VH group, 205 malignancies were detected (23% cancer detection rate). The detection rate was higher for those with asymptomatic VH (24.6%) than for those with symptomatic VH (15.4%). The cancer detection rate for symptomatic NVH was 9.1%, with only three cancers diagnosed in those younger than 60 years of age. For asymptomatic NVH, the cancer detection rate was only 1.5%, with a total of eight urological malignancies diagnosed in patients aged 60 years or older.Conclusions: The new Danish referral pathway has an acceptable capture rate for patients presenting with haematuria of all severities. The overall cancer detection rate of 14.5%, and 23% for patients with VH in this study, is an important validation of previous studies. A cancer detection rate of greater than 30% was shown in patients with VH over 70 years old.