FORT SAM HOUSTON, TX — The discovery of blood in the urine might be alarming, but do patients with microscopic hematuria (MH) and a negative initial evaluation have an elevated risk for urinary carcinoma?
A recent study in Abdominal Radiology sought to find out. Researchers from Brooke Army Medical Center at Fort, Sam Houston, TX, and the Uniformed Services University of the Health Sciences in Bethesda, MD, conducted a population-based retrospective study with a matched control. The study team identified 8465 adults with an MH ICD code, an initial negative urinary malignancy workup of cystoscopy and CT urography and at least 35 months of clinical care. Those were matched to 8465 hematuria naïve controls by age, gender and smoking status.
The results indicated there was no statistically significant difference in urinary malignancy rates (p > 0.05) with microscopic hematuria. The study also found the following comparisons:
- Any urinary cancer: cases 0.74% (63/8465; 95% CI 0.58-0.95%)/controls 0.83% (71/8465; 95% CI 0.66-1.04%%) (p = 0.54);
- bladder: 0.45%/0.47% (p = 0.82);
- renal: 0.31%/0.38% (p = 0.43);
- ureteral: 0.01%/0.02% (p = 0.56).
The situation was different with more visible blood, however. “Subsequent gross hematuria in both males and females increased the odds of cancer: males 2.35 (p = 0.001; CI 1.42-3.91); females 4.25 (p < 0.001; CI 1.94-9.34),” the researchers wrote. “Males without additional hematuria had decreased odds ratio: 0.32 (p = 0.001; CI 0.16-0.64). Females without additional hematuria 0.58 (p = 0.19; CI 0.26-1.30) and both genders with additional unspecified hematuria/microscopic hematuria males 1.02 (p = 0.97; CI 0.50-2.08) and females 1.00 (p = 0.99; CI 0.38-2.66) did not have increased odds ratios (p > 0.05).”
The authors concluded that MH patients with initial negative evaluation have a subsequent urologic malignancy rate of less than 1% and likely do not need further urinary evaluation, unless they develop gross hematuria.
- Lisanti CJ, Graeber A, Syed H, Moeck A, et. al. What is the relative risk of urologic malignancy in microscopic hematuria patients after negative evaluation? A long-term population-based retrospective analysis of 8465 patients. Abdom Radiol (NY). 2023 Mar;48(3):1011-1019. doi: 10.1007/s00261-022-03793-x. Epub 2023 Jan 2. PMID: 36592198.