Investigation of non-visible haematuria in a tertiary urology service

Abstract

Aim
Non-visible haematuria (NVH) is a common reason for referral to urology services. There is contrasting guidelines internationally regarding its investigation. The aim of this study is to investigate the rate of detection and resource burden of NVH on a tertiary urology service.

Methods
A retrospective chart review was performed which identified patients who were investigated for NVH from July 2023 to July 2024. Data was collected on patient demographics, indication, findings, and radiological imaging. Information regarding cost of investigations were also obtained.

Results
A total of 1,868 flexible cystoscopies were reviewed, with 175 (9.4%) indicated for NVH. One clinical diagnosis of bladder tumour was identified, and two cystoscopies identified an erythematous area warranting biopsy, both of which were benign. Imaging identified three patients with findings requiring follow-up imaging. Cost of flexible cystoscopy is estimated at €609, ultrasound imaging €102, CT imaging €170, and outpatient clinic appointment €150. This equates to minimum cost of €861 for investigation of NVH.

Discussion
Non-visible haematuria has a detection rate of 6% for urological malignancy in recent large volume studies2,3. Investigation contributes to a significant resource burden. Additionally, the risk to patients of these investigations must be considered. We welcome universal terminology and guidelines to be established.