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.