Assessment and Clinical Significance of Haematuria in Malaysian Patients - Relevance to Early Cancer Diagnosis

Aim: To study the causes and significance of both microscopic and macroscopic haematuria in adult patientsand assess possible relevance to early detection of urological cancers.
Methods: 417 patients presenting withhaematuria were assessed in our Urology Unit. Following confirmation of haematuria, these patients weresubjected to imaging techniques and flexible cystoscopy. Parameters analysed included clinical characteristics,imaging results, flexible cystoscopy findings, time delay to diagnoses and eventual treatment and final diagnosesof all cases.
Results: 390 haematuria cases were analysed from 417 consecutive patients with haematuria. After27 cases were excluded as they had previous history, 245 microscopic and 145 macroscopic. Age range was 17 to95 years old with predominance of 152 females to 239 males. The racial distribution included 180 Chinese, 100Indians,95 Malays and 15 other races. The final diagnoses were benign prostatic hyperplasia (22.6%), no causefound (22.3%), other causes (18.7%), urolithiasis (11.5%), urinary tract infection UTI (10.8%), non specificcystitis (10.3%), bladder tumours (2.8%) and other genitourinary tumours (1%). 11 new cases (2.8%) of bladdercancers were diagnosed, with a mean age of 59 years. Only 3 of 245 (1.2%) patients with microscopic haematuriahad newly diagnosed bladder tumour compared with 8 of 145 (5.5%) patients with frank haematuria (p=0.016).Mean time taken from onset of symptoms to diagnosis of bladder cancer was 53.3 days with definitive treatment(TURBT) in 20.1 days from diagnosis.
Conclusion:- This study has highlighted the common causes of haematuriain our local setting. We recommend that full and appropriate investigations be carried out on patients with frankhaematuria especially those above 50 years old in order to provide earlier detection and prompt managementof bladder diseases especially tumours.