Bernd J Schmitz-Dräger1, Eva C Kuckuck2, Tahlita C M Zuiverloon3, Ellen C Zwarthoff4, Amanda Saltzman5, Abhishek Srivastava6, M'Liss A Hudson7, Roland Seiler8, Tilmann Todenhöfer9, Antonia Vlahou10, H Barton Grossman11, Mark P Schoenberg6, Marta Sanchez-Carbayo12, Lenuta-A Brünn13, Bas W G van Rhijn14, Peter J Goebell15, Ashish M Kamat11, Morgan Roupret16, Sharokh F Shariat17, Lambertus A Kiemeney3. 1. Urologie 24/Urologie Schön Klinik Nürnberg Fürth, Europa-Allee 1, Fürth, Germany; Department of Urology, Friedrich-Alexander-Universität, Erlangen, Germany. Electronic address: bernd_sd@yahoo.de. 2. Urologie 24/Urologie Schön Klinik Nürnberg Fürth, Europa-Allee 1, Fürth, Germany. 3. Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. 4. Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. 5. Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA. 6. Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY. 7. Department of Urology, Diagnostic Clinic of Longview, Longview, TX. 8. Department of Urology, Inselspital, University of Berne, Berne, Switzerland; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. 9. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Department of Urology, Eberhard-Karl University, Tübingen, Germany. 10. Division of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece. 11. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX. 12. Lucio Lascaray Research Center, University of the Basque Country, Vitoria-Gasteiz, Spain. 13. Urologische Klinik, St. Franziskus Hospital, Bielefeld, Germany. 14. Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands. 15. Department of Urology, Friedrich-Alexander-Universität, Erlangen, Germany. 16. Pitié Salpétrière Hospital, Assistance Publique- Hopitaux de Paris, University Paris 6, Paris, France. 17. Department of Urology, Medical University of Vienna, Vienna, Austria.
Abstract
RATIONALE: Assessment of patients with asymptomatic microhematuria (aMh) has been a challenge to urologists for decades. The aMh is a condition with a high prevalence in the general population and also an established diagnostic indicator of bladder cancer. Acknowledging aMh needs to be assessed within a complex context, multiple guidelines have been developed to identify individuals at high risk of being diagnosed with bladder cancer. MATERIAL & METHODS: This structured review and consensus of the International Bladder Cancer Network (IBCN) identified and examined 9 major guidelines. These recommendations are partly based on findings from a long-term study on the effects of home dipstick testing, but also on the assumption that early detection of malignancy might be beneficial. RESULTS: Despite similar designs, these guidelines differ in a variety of parameters including definition of aMh, rating of risks, use of imaging modalities, and the role of urine cytology. In addition, recommendations for further follow-up after negative initial assessment are controversial. In this review, different aspects for aMh assessment are analyzed based upon the evidence currently available. DISCUSSION: We question whether adherence to the complicated algorithms as recommended by most guidelines is practical for routine use. Based upon a consensus, the authors postulate a need for better tools. New concepts for risk assessment permitting improved risk stratification and prepone cystoscopy before refined imaging procedures (computed tomography scan and magnetic resonance imaging) are suggested.
RATIONALE: Assessment of patients with asymptomatic microhematuria (aMh) has been a challenge to urologists for decades. The aMh is a condition with a high prevalence in the general population and also an established diagnostic indicator of bladder cancer. Acknowledging aMh needs to be assessed within a complex context, multiple guidelines have been developed to identify individuals at high risk of being diagnosed with bladder cancer. MATERIAL & METHODS: This structured review and consensus of the International Bladder Cancer Network (IBCN) identified and examined 9 major guidelines. These recommendations are partly based on findings from a long-term study on the effects of home dipstick testing, but also on the assumption that early detection of malignancy might be beneficial. RESULTS: Despite similar designs, these guidelines differ in a variety of parameters including definition of aMh, rating of risks, use of imaging modalities, and the role of urine cytology. In addition, recommendations for further follow-up after negative initial assessment are controversial. In this review, different aspects for aMh assessment are analyzed based upon the evidence currently available. DISCUSSION: We question whether adherence to the complicated algorithms as recommended by most guidelines is practical for routine use. Based upon a consensus, the authors postulate a need for better tools. New concepts for risk assessment permitting improved risk stratification and prepone cystoscopy before refined imaging procedures (computed tomography scan and magnetic resonance imaging) are suggested.