Abstract

OBJECTIVE: The objective of this study was to assess microscopic hematuria as a risk factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms presenting for urodynamics at a tertiary care urogynecology practice. METHODS: We conducted a retrospective cohort analysis of all women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy at our institution from January 2001 to March 2004. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy results were recorded. Cytology and biopsy results were collected when a lesion was detected at cystoscopy. Statistical analyses consisted of univariate statistics, Student t test, chi square, Fisher exact test, and multivariate logistic regression when appropriate. RESULTS: Of 735 patients with irritative voiding symptoms, 264 (35.9%) women with microscopic hematuria defined our cases and the remaining 471 (64.1%) without hematuria represented our control group. These 2 groups were similar in age, race, parity, tobacco use, and family history of bladder cancer. Bladder cancer was detected in 3 women for an overall detection rate of 0.4%. Microscopic hematuria, urgency, urge incontinence, frequency, dysuria, nocturia, age, and tobacco use were analyzed using both univariate analysis and multivariate logistic regression. None of these independent variables was significantly associated with bladder cancer. In fact, microscopic hematuria was absent in 2 of the 3 cases of bladder cancer. To analyze cost, we accounted for the 735 cystoscopies and 31 additional cystoscopies with biopsy needed to detect the 3 cases of cancer. We estimated costs based on Medicare global reimbursements of $195 per cystoscopy and $602 per cystoscopy with biopsy, which resulted in an average cost of $220 per patient for diagnosis. Given our bladder cancer rate of 0.4% (one case per 250 patients), the overall cost to detect a single case of bladder cancer was $55,000. CONCLUSION: In this cohort of women with irritative voiding symptoms, no risk factors for bladder cancer were identified. The cases of bladder cancer were only detected by direct visualization at cystoscopy with follow-up biopsy at a cost of $55,000 per cancer case.

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