Blood in Urine is Cancer until Proven Otherwise
- The major difference between microscopic and gross hematuria is the incidence of significant pathology.
- Dipstick test needs to be confirmed with microscopic urinalysis
Microscopic Hematuria
1-2% risk of malignancy; up to 5% with multiple risk factors
Gross Hematuria
18% risk of malignancy; up to 30% with multiple risk factors
Risk Factors
INCREASE IN INCIDENCE
- Age >40
- History of Smoking
- Prior Pelvic Radiation
(Colon, Prostate, Uterine) - >25 RBCs/HPF
- 3 times
- 4 times
- 2 times
- 12 times
Population-based standardized incidence ratios of bladder cancer.
Blood in Urine is Cancer until Proven Otherwise
- Bladder cancer is the most common diagnosis in patients with hematuria after kidney stones and BPH in men.
- The symptoms of benign diseases are often indistinguishable from malignant or life-threatening causes.
- Bladder cancer can present with symptoms similar to UTI: frequency, urgency, nocturia.
- Natural history of gross hematuria is that it may often resolve spontaneously only to recur. Empiric treatment with antibiotics may give an impression that antibiotics are effective.
2.4 % of men and women will be diagnosed with bladder cancer
- Patients on blood thinners have similar rates of malignancy after evaluation for hematuria as those not on anticoagulant medications.
- The risks are increased in current smokers; risk persists as long as 20 years after cessation of smoking
- Bladder cancer is the most common secondary cancer after radiation to the prostate.
Fewer than 15% of patients with hematuria receive the recommended evaluation within 1 year of initial diagnosis
- “incidence and mortality rates have changed very little over the past 20 years” according to the (NCI).
- Early detection is the key to improved survival. Delay in bladder cancer treatment by 90 days is associated with higher mortality rates.