ORLANDO, FL (UroToday) - A group from Amsterdam reported their experience with clinic patients presenting with hematuria are evaluated according to a guideline which was developed by the Dutch Urological Association (DUA) in 1998.

All patients of 40 years and older, should be evaluated using the following tests: urine sample analysis and cytology, blood hemoglobin and creatinine, ultrasonography of the kidneys, intravenous urography, and cystoscopy. In an earlier stage they investigated the outcome of such analysis in a retrospective study. Moreover they checked the proper use of the guideline. The guideline was completely followed in only 34% of patients. It turned out that in most cases urine cytology was not executed.

After policy-adjustments the guideline, in a prospective study, was completely followed in over 90% of patients. It was remarkable that this improvement did not change the outcome; cancer was still found in roughly 17% of the patients. Based on this observation routine urine cytology might be of limited value in the primary valuation of patients with hematuria.

Removing urine cytology as a standard diagnostic tool could lead to cost reduction and efficiency with maintenance of quality of care. The aim of the present study was to check this hypothesis.

In 2005 a retrospective evaluation was conducted in 1253 patients with hematuria. Recently, in 2006, a prospective evaluation of 588 patients, 40 years of age and older and presenting with microscopic or gross hematuria, followed.. All patients were evaluated according to the DUA guideline "hematuria". The patient characteristics, performed tests and diagnosis were recorded in a database. All patients with abnormal cytology were identified (EORTC [Papanicolaou] classification 2-5).

The database contains a total of 1,841 patients of 40 years and older. Abnormal cytology was found in 204 patients. 111 patients had classification 4 or 5 (suspected) and 93 patients a classification 2 or 3 (atypical). Of these 204 patients, 128 were diagnosed with a transitional cell carcinoma of the bladder, 2 of the ureter, 3 of the pyelum and 1 adenocarcinoma renis. 70 patients did not have a carcinoma diagnosed, all of them with a classification 2 or 3. All patients were diagnosed by means of cystoscopy and/or radiological investigations. None of the patients finally diagnosed with cancer had only suspected cytology.

Based on the results of the present study urine cytology is of no added value in the initial routine work-up for patients with hematuria. This may result in cost reduction and efficiency with maintenance of quality of care.

Presented by Marina C Hovius, MD, Lara C Schreuders, MD, Roos W Wieringa, MD, Guido M Kamphuis, MD, Eddi A Heldeweg, MD, and George van Andel, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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