Poster, Podium & Video Sessions
Presentation Authors: Kyle Richards*, Madison, WI, Daniel Murphy, Houston, TX, Vania Lopez, Tracy Downs, Jason Abel, David Jarrard, Madison, WI, Hardeep Singh, Houston, TX
Introduction: Painless gross hematuria (GH) is more likely to be associated urologic malignancy when compared to asymptomatic microscopic hematuria (AMH). However, the presence of either GH or AMH should prompt timely urologic evaluation in the absence of an obvious benign cause. The objective of our study is to evaluate whether presentation with GH or AMH was associated with a timely evaluation of patients that present with hematuria.
Methods: We performed a retrospective electronic health record (EHR) review of 190 consecutive patients who presented with new onset hematuria to a Veterans Affairs (VA) facility between 10/1/2011 and 12/31/2012. The VA&[prime]s EHR offers a comprehensive longitudinal picture of the patient&[prime]s diagnostic journey. We excluded patients who sought diagnostic care outside the institution (n=22), patients with cystoscopy within 3 years prior (n=9), patients with hematuria in the setting of active urinary tract infection (n=3), and patients with terminal illness (n=1). We collected detailed patient demographic data, medical/psychiatric history, and times to diagnostic evaluation (abdominal imaging, urologic referral, and cystoscopy). We defined &[prime]delay&[prime] when diagnostic evaluation was not completed within 60 days from new onset hematuria. Multivariable logistic regression was performed to identify predictors of delay.
Results: After exclusions, 76 (50.7%) patients were found to have new AMH and 74 (49.3%) new GH. Patients with GH had higher rate of urology referral than AMH (83.8% vs. 57.9%; p<0.001) and were more likely to undergo cystoscopy (75.7% vs. 50%; p=0.001). Delays occurred in 65.8% of AMH patients and 64.9% of GH patients (p=0.9). There was no difference in median days to abdominal imaging completion (33 vs. 27.5, p=0.07), urology referral completion (30 vs. 23.5, p=0.12), or time to cystoscopy completion (71.5 vs. 69, p=0.73) between those presenting with AMH vs. GH. On multivariable logistic regression, there were no variables that predicted lack of action within 60 days. Within one year-post presentation, 1.3% of patients with AMH and 20.3% of patients with GH were found to have bladder neoplasms.
Conclusions: GH is approximately 20 times more likely to be associated with bladder cancer compared to AMH. Approximately 2/3 of patients with any hematuria were not evaluated within 60 days of presentation. Strategies to reduce these delays are warranted.
Source Of Funding: None
University of Wisconsin-Madison
Kyle A. Richards MD is an assistant professor at the Unversity of Wisconsin in the Department of Urology. He is a health services researcher, a practicing urologic oncologist, and Chief of Urology at the William S. Middleton Memorial Veterans Hospital. He has a special interest in the care of patients with bladder cancer and works to improve the quality of care for these patients.
Tuesday, May 16
9:30 AM – 11:30 AM