You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2016MP01-12 PREDICTORS OF GENITOURINARY MALIGNANCY AMONG PATIENTS WITH PRIMARY MICROSCOPIC HEMATURIA Paras Shah, Patrick Samson, Derek Friedman, Karly Stoltman, Vinay Patel, Simpa Salami, Andrew Ng, Manaf Alom, Jessica Kreshover, Joph Steckel, Manish Vira, Lee Richstone, Louis Kavoussi, and Justin Han Paras ShahParas Shah More articles by this author , Patrick SamsonPatrick Samson More articles by this author , Derek FriedmanDerek Friedman More articles by this author , Karly StoltmanKarly Stoltman More articles by this author , Vinay PatelVinay Patel More articles by this author , Simpa SalamiSimpa Salami More articles by this author , Andrew NgAndrew Ng More articles by this author , Manaf AlomManaf Alom More articles by this author , Jessica KreshoverJessica Kreshover More articles by this author , Joph SteckelJoph Steckel More articles by this author , Manish ViraManish Vira More articles by this author , Lee RichstoneLee Richstone More articles by this author , Louis KavoussiLouis Kavoussi More articles by this author , and Justin HanJustin Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1842AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The current AUA guidelines to evaluate microscopic hematuria (MH) are tailored to screen for malignant causes of hematuria using urine studies, imaging, and endoscopic procedures. However, the guidelines promote near universal application of multiphasic computed tomography (CT) with intravenous contrast, in addition to cystoscopy for complete evaluation of MH. These broad requirements were based on existing literature but may be overly indiscriminate in determining which patients would benefit most from a thorough investigation. In efforts to improve the utility of the MH workup and to minimize the risk of over-screening with CT imaging and cystoscopy, we sought to identify which factors are predictive of urologic malignancy among a large cohort of patients undergoing workup for MH. METHODS A retrospective review of 2736 consecutive patients who underwent urologic evaluation for MH between 2012 and 2015 was conducted. Patients with gross hematuria, prior urologic malignancy, chronic indwelling catheter, and glomerular disease were excluded. The risk factors specified by the current AUA MH guidelines include smoking history, irritative voiding symptoms, chemotherapy exposure, and pelvic irradiation. Univariate and multivariate logistic regression analyses were performed to explore the association between these risk factors and the presence of genitourinary malignancy. Covariates analyzed included age, gender, number of RBC/HPF (<50 versus ≥50), and previous urologic history (e.g. BPH, stones). RESULTS Among 1761 patients evaluated for first-time MH, 15 (0.85%) urologic malignancies were detected, including 7 renal cancers and 8 bladder cancers. On multivariate analysis, male gender (HR=4.16, p=0.04), positive smoking history (HR=6.02, p=0.01), and presence of irritative voiding symptoms (HR=5.99, p=0.01) significantly increased risk for urologic malignancy. Age >50 years was associated with malignancy on univariate, but not multivariate analysis. Chemotherapy exposure, pelvic irradiation and number of RBC on urinalysis were not predictive of malignancy. CONCLUSIONS MH can serve as an early indicator of urologic malignancy, however, its presence may not always warrant a comprehensive work-up. Male gender, positive smoking history, and irritative voiding symptoms were identified as risk-factors independently predictive of malignancy and thus, their presence justifies a thorough evaluation. In patients without these risk factors, the universal application of CT urography should be judiciously considered. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e5-e6 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paras Shah More articles by this author Patrick Samson More articles by this author Derek Friedman More articles by this author Karly Stoltman More articles by this author Vinay Patel More articles by this author Simpa Salami More articles by this author Andrew Ng More articles by this author Manaf Alom More articles by this author Jessica Kreshover More articles by this author Joph Steckel More articles by this author Manish Vira More articles by this author Lee Richstone More articles by this author Louis Kavoussi More articles by this author Justin Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Read full abstract