# Urothelial Malignancy After Normal Hematuria Clinic Investigations: Does Non-visible Hematuria Need Re-investigation?

## TL;DR

This study finds that non-visible hematuria is unlikely to lead to urothelial cancer, while visible hematuria may require further investigation.

## Contribution

The study provides long-term follow-up data on patients with normal hematuria clinic investigations and evaluates the need for re-investigation based on visible vs. non-visible hematuria.

## Key findings

- No patients with non-visible hematuria developed urothelial malignancy during follow-up.
- The urothelial malignancy rate was 5.7% in those re-referred with visible hematuria.
- Overall malignancy and mortality rates remained low after initial normal investigations.

## Abstract

Hematuria is the most common referral to Urology. Most initial evaluations are normal; however there are few medium- to long-term studies about these patients after they are discharged.

This study was a retrospective observational case–control study. Patients with normal initial investigations in our hematuria clinic (HC) over a 2-year period in 2012-2013 were included. We reviewed the electronic records of patients choosing January 1, 2021, as our reference date providing a median follow-up of 99 months. The primary aim of this study was to assess the missed urothelial malignancy (UM) rate in this cohort and also the UM rate in those re-referred to the HC.

The study included 573 patients of whom 24.6% (141/573) were re-referred to urology during the study period. The overall missed UM cancer rate was 0.5% and 0.2% died as a result in this follow-up period. The UM cancer rate in those re-referred was 4.3% and of those re-referred with visible hematuria (VH) the UM cancer rate was 5.7%. No patients re-referred with non-visible VH (NVH) were diagnosed with UM. The only urological death during this time was due to UM.

All urological malignancy and mortality remain very low even at medium- to long-term follow-up after an initial normal HC investigation. In this study, no patients with recurrent NVH developed UM; therefore, recurrent NVH is unlikely to need reinvestigation. The risk of UM in those re-referred with VH is low but more substantial and warrants reinvestigation, which should include computed tomography urogram imaging.