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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

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate whether microscopic hematuria (MH) patients with a negative initial evaluation have an elevated risk for urinary carcinoma.

Methods

This is a population-based retrospective study with a matched control identified 8465 adults with an MH ICD code, an initial negative urinary malignancy work-up of cystoscopy and CT urography, and at least 35 months of clinical care. 8465 hematuria naïve controls were age, gender, and smoking status matched. Subsequent coding of non-prostatic urinary cancer, or any following hematuria codes: additional microscopic unspecified or unspecified hematuria, and gross hematuria was obtained. Χ2 tests were performed.

Results

There was no statistically significant difference in urinary malignancy rates (p > 0.05). 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). 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). 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).

Conclusion

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.

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Acknowledgements

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Authors and Affiliations

  1. Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA

    Christopher J. Lisanti, Adam Graeber, Helal Syed, Adam Moeck, James K. Aden & Ryan Schwope

  2. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Christopher J. Lisanti & Ryan Schwope

  3. Defense Healthcare Management Systems, San Antonio, TX, USA

    Alexander G. Rittel

  4. Loma Linda University School of Medicine, Loma Linda, CA, USA

    Forrest Jellison

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  1. Christopher J. Lisanti
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  2. Adam Graeber
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CJL, AGR, AM, AG, HS, and JKA The first draft of the manuscript was written by AG and CJL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Christopher J. Lisanti.

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Lisanti, C.J., Graeber, A., Syed, H. 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 48, 1011–1019 (2023). https://doi.org/10.1007/s00261-022-03793-x

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  • DOI: https://doi.org/10.1007/s00261-022-03793-x

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