A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic

OBJECTIVE To clarify the prevalence of disease as determined by age, sex and the degree of haematuria at presentation, and to ascertain the merits of using ultrasonography (US), i.v. urography (IVU) or both when imaging the upper urinary tract, in a prospective cohort of patients attending a protocol-based haematuria clinic. PATIENTS AND METHODS In a two-tier protocol, as a part of first-line investigation, all 4020 patients attending the clinic between October 1998 and August 2003 had US and flexible cystoscopy. Subsequently, IVU was used where indicated following abnormal first-line tests and in patients with persistent haematuria where no abnormality had been detected. RESULTS In all, 2627 men and 1393 women presented with microscopic (53.2%) or macroscopic haematuria (46.8%). The overall prevalence of malignant disease was 12.1%, but for macroscopic haematuria it was 18.9% and for microscopic haematuria 4.8%. Age and sex also influenced the observed rates of disease. Of the upper tract tumours, 70 were identified after abnormal US, with three cases of transitional cell carcinoma identified on IVU after a normal US. CONCLUSIONS The study provides a rationale for the appropriate investigation of all patients, moderated by the age, sex and degree of haematuria, and the ubiquitous use of US with selective IVU based on age, sex and degree of (and persistence of) haematuria.