Haematuria: a three year experience in a specialist urological facility in Sri Lanka.

Abstract

Objective: Haematuria  is  an alarm sign which needs exclusion of sinister pathology. Data regarding haematuria  is  sparse  in  Sri  Lanka. Our objective was to identify the age related causes, associated  presentations of benign & malignant conditions and to assess the success of diagnostic tools in achieving the proper diagnosis in patients with haematuria.
Methods: We  retrospectively  analyzed  our  database  consisting  of 332 Patients over 3 years.
Results: Mean  age  was  56.13 (range 4 – 91), age  related  causes  of  haematuria  are  as  follows.

Cause of haematuria

<40 (n=69)

Calculi(81.5%)

UTI (12.3%)

Malignancy(6%)

>40 (n=263)

Malignancy(41%)

Calculi(31%)

Vascular prostate(11%)

Majority  were  males (75%).  Overall, 34%(n=113) patients  had  malignancies  and 66%(n=219) had benign disease. LUTS(44%),  pain(45.5%),  retention of urine(14.8%), Fever(7.2%)  were  the  common  associated  presentations. Passage  of  clots(16.6%), particulate matter(11.4%)  pneumaturia,  had  significant  relationship  to  malignancies.
62.7%(n=208) had frank haematuria of which 40.4%(n=84) had malignancies. Of the 37.3%(n=124) with microscopic haematuria, 23.4%(n=29)  were malignant. Of the 54.5%(n=181)  who  had  painless  haematuria, 50.3%(n=91)  were  malignant. Only 14.6% of those with painful haematuria had cancer. Overall, 47.8% were TCC, 34% RCC & 17.4% Prostate Carcinoma.Physical  examination,  urine  analysis  and basic imaging had a diagnostic  yield  of over 80%, uro-endoscopy  was  needed  to  diagnose  further  8%  patients.  3%  patients  would  have missed  the diagnosis  if  not  for  axial  imaging.

Conclusions: The high proportion of cancer and overall diagnostic yield in patients with haematuria emphasizes  the   need  for  comprehensive  evaluation. Lack  of  pain,  passage  of clots, particles  &  pneumaturia  had  notable  associations  with  malignancy.