ARRS 2022 Abstracts

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E1535. Cohort Analysis of Urologic Malignancy in Microscopic Hematuria Patients After Initial Negative Evaluation with CT Urography and Cystoscopy
Authors
  1. Christopher Lisanti; Brooke Army Medical Center; Uniformed Services University of the Health Sciences
  2. Adam Graeber; Brooke Army Medical Center
  3. Helal Syed; Brooke Army Medical Center
  4. Adam Moeck; Brooke Army Medical Center
  5. Alex Rittel; Defense Healthcare Management Systems
  6. Ryan Schwope; Brooke Army Medical Center; Uniformed Services University of the Health Sciences
  7. Forrest Jellison; Loma Linda University School of Medicine
Objective:
The vast majority of patients with microscopic hematuria (MH) have a negative initial evaluation; however, it is unknown if their malignancy risk remains elevated. The purpose of our study is to identify if patients with MH and a negative initial evaluation still have an elevated risk for urinary carcinoma.

Materials and Methods:
In this IRB-approved study, the Military Health System (MHS) Management Analysis and Reporting Tool retrospectively identified adult patients with an MH ICD code who had an initial negative work-up of cystoscopy and CT urography (CTU) for malignancy and at least 35 months of clinical care. MH patients were matched by age, sex, smoking status, and follow-up time to hematuria naïve control patients in a 1:1 ratio. Cases and controls were identified who subsequently developed bladder, renal, ureteral cancer, or any of the following hematuria codes: additional microscopic unspecified or unspecified hematuria or gross hematuria. Descriptive statistics and chi-square tests were analyzed.

Results:
A total of 8826 patients with MH and 8826 control patients comprised our study. Case/control percentages of patients with any urinary cancer, subdivided by bladder, renal, and ureteral cancers, showed no statistically significant difference: 0.78% vs 0.93% (p = 0.29), 0.50% vs 0.53% (p = 0.75), 0.31% vs 0.42% (p = 0.21), and 0.02% vs 0.02% (p = 1.0), respectively. Study patients with any urinary cancer incidence were subdivided by subsequent hematuria codes: no additional hematuria 0.33% (18/5530); additional microscopic unspecified/unspecified hematuria 0.78% (14/1803); gross hematuria 2.48% (37/1493). Odds ratios by sex and additional hematuria coding compared to entire control cohort were as follows: 0.27 (p < 0.0002; 95% CI : 0.14–0.54) for males, 0.53 (p = 0.12; CI: 0.24–1.18) for females without additional hematuria; additional unspecified hematuria/microscopic hematuria 0.85 (p = 0.65; CI: 0.42–1.72) for males, 0.91 (p = 0.085; CI: 0.35–2.40) for females; additional gross hematuria 2.16 (p < 0.002; CI: 1.33–3.49) for males, 3.90 (p < 0.0001; CI:1.97–7.70) for females.

Conclusion:
Patients with MH and an initial negative evaluation have a subsequent urinary malignancy rate the same as a cohort without MH. Subsequent development of gross hematuria demonstrated a marked increase of malignancy. Patients with MH and a negative evaluation of cystoscopy and CTU may not need further urinary evaluation unless they develop gross hematuria.