Kuckuck, Eva Charlotte and Hennenlotter, Jorg and Todenhoefer, Tilman and Bruenn, Lenuta-Ancuta and Rass, Georg-Christian and Stenzl, Arnulf and Hakenberg, Oliver W. and Roghmann, Florian and Goebell, Peter J. and Grimm, Marc-Oliver and Pycha, Armin and Bolenz, Christian and Burger, Maximilian and Benderska-Soeder, Natalya and Schmitz-Draeger, Bernd J. (2023) Discriminative capacity of guideline recommendations in the assessment of patients with asymptomatic microhematuria. UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 41 (5). ISSN 1078-1439, 1873-2496
Full text not available from this repository.Abstract
Background & Objective: Asymptomatic microhematuria (aMh) remains a diagnostic challenge in urological practice: while aMh is a risk factor of urothelial carcinoma (UC), prevalence of aMh is high. Guidelines were developed to permit risk stratification and reduce diag-nostic workload. This study investigates the efficacy of several recommendations.Material & Methods: Sixty hundred eight patients with newly diagnosed aMh without previous UC from an academic referral center (A; n = 320) and a private outpatient clinic (B; n = 288) were included. All patients underwent clinical workup including medical history, urine cytology, upper tract imaging and cystoscopy. Eleven former and current guidelines were applied to each patient individually; every patient was classified as either low risk (no further workup recommended) or high risk. Furthermore, a recently developed nomogram for hematuria assessment was included. Results: The cohort comprised 142 females and 466 males (mean age 62 [range 18-92] years). Sixty-one patients (10.0%) were diagnosed with UC. Excluding the Swedish and recent NICE guideline generally advising against urologic workup, application of 9 other recommendations would have diagnosed all UCs and saved 1.6% to 16.1% of patients from workup. For the 2020 US guideline, solely applied to cohort B, 10.6% of patients were classified as low risk. The use of the nomogram would have saved 17.1% to 25% of patients from workup.Conclusions: Practical relevance of current guidelines is limited as they do not sufficiently identify patients not requiring clinical work up. Thus, guideline adherence may trigger overdiagnosis and even overtreatment. New ways of risk stratification are needed to improve aMh assessment.& COPY; 2022 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | BLADDER-CANCER; MICROSCOPIC HEMATURIA; RISK; ASSOCIATION; MANAGEMENT; ADULTS; CARE; MEN; AUA; Bladder cancer; Disease management; Guidelines; Microhematuria; Nomogram; Risk factors |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Jan 2024 13:40 |
| Last Modified: | 30 Jan 2024 13:40 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60527 |
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