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World Journal of Urology
Published in: World Journal of Urology 6/2012

01-12-2012 | Original Article

Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer

Authors: Eugene K. Cha, Lenuta-Ancuta Tirsar, Christian Schwentner, Joerg Hennenlotter, Paul J. Christos, Arnulf Stenzl, Christine Mian, Thomas Martini, Armin Pycha, Shahrokh F. Shariat, Bernd J. Schmitz-Dräger

Published in: World Journal of Urology | Issue 6/2012

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Abstract

Purpose

Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic hematuria the risk of having bladder cancer can be predicted with high accuracy. Toward this end, we analyzed risk factors in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.

Methods

Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses. The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.

Results

Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7 %) had bladder cancer. Increasing age (OR = 1.03, p < 0.0001), smoking history (OR = 3.72, p < 0.0001), gross hematuria (OR = 1.71, p = 0.002), and positive cytology (OR = 14.71, p < 0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1 % accuracy for predicting the presence of bladder cancer.

Conclusions

Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.
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Metadata
Title
Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer
Authors
Eugene K. Cha
Lenuta-Ancuta Tirsar
Christian Schwentner
Joerg Hennenlotter
Paul J. Christos
Arnulf Stenzl
Christine Mian
Thomas Martini
Armin Pycha
Shahrokh F. Shariat
Bernd J. Schmitz-Dräger
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 6/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-012-0979-x

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