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RISK-BASED HEMATURIA REFERRAL PATTERNS AT A LARGE SINGLE INSTITUTION IN PATIENTS WITH NO PREVIOUS UROLOGIC EVALUATION
Hematuria (microhematuria [MH] or gross hematuria [GH]) is one of the most common urologic referrals. Recent AUA MH guidelines suggest risk stratifying patients into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on age, smoking history, and number of red blood cells (RBCs) o...
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| Published in: | Urologic oncology 2024-03, Vol.42, p.S66-S67 |
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| Main Authors: | , , , , |
| Format: | Article |
| Language: | English |
| Online Access: | Get full text |
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| Summary: | Hematuria (microhematuria [MH] or gross hematuria [GH]) is one of the most common urologic referrals. Recent AUA MH guidelines suggest risk stratifying patients into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on age, smoking history, and number of red blood cells (RBCs) on urinalysis (UA) to determine the recommended urologic work up. While urologists are familiar with these guidelines, non-urology providers are commonly the first to diagnose hematuria in patients, such as on routine UA. We sought to describe the referral patterns, specifically based on MH risk factors and risk-stratification, for patients with hematuria who have previously never been evaluated by Urology.
Between 1/1/2020 and 7/15/2023, all patients with hematuria, defined as;≥;3 red blood cells on high-powered microscopy, diagnosed on urinalysis at a single large academic medical center were retrospectively reviewed. Only patients with urinalyses ordered in the outpatient setting were included (i.e. urinalyses from inpatient and emergency units were excluded). Patients with any prior history of urothelial cancer, ovarian cancer, or CKD-IV were excluded, in addition to patients with a diagnosis of nephrolithiasis, prostate cancer, kidney cancer, kidney transplant, or chemotherapy use within the past 2 years prior to the hematuria event. 5450 patients with a hematuria episode (MH or GH) and no prior urologic evaluation were available for analysis.
Median patient age was 62 (IQR 52.0-74.0). Seventy seven percent of patients were female. 3108/5450 (57%) patients were high risk, 1086/5450 (20%) were intermediate risk, and 1256/5450 (23%) were low risk based on AUA MH Guidelines Risk Categories. Within the cohort, 815 referrals to Urology were placed (14.9% overall referral rate). Of the patients referred to Urology, 75% (613/815) were seen in a Urology clinic. Men were more likely to be referred to Urology than women (23.5% vs. 12.4%, p=0.001). In both male and female patients, referral rates were higher in patients who were HR based on age, number of RBCs on UA, and smoking history when each of these risk factors were analyzed individually (Table 1). Referral rates for high, intermediate, and low risk patients based on overall AUA MH Guidelines Risk Categories were 18%, 14%, and 7%, respectively (p=0.001) (Table 2).
Approximately 15% of patients with hematuria in a large academic cohort of patients without prior urologic evaluation were referred to Urology after. |
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| ISSN: | 1078-1439 1873-2496 |
| DOI: | 10.1016/j.urolonc.2024.01.192 |