Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis

Ibrahim Jubber; Shahrokh F Shariat; Samantha Conroy; Wei Shen Tan; Patrick C Gordon; Yair Lotan; Edward M Messing; Arnulf Stenzl; Bas van Rhijn; John D Kelly; James W F Catto; Marcus G Cumberbatch

doi:10.1016/j.eururo.2019.10.010

Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis

Eur Urol. 2020 May;77(5):583-598. doi: 10.1016/j.eururo.2019.10.010. Epub 2019 Nov 30.

Authors

Affiliations

¹ Academic Urology Unit, University of Sheffield, Sheffield, UK.
² Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
³ Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
⁴ Department of Urology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK.
⁵ Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
⁶ University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
⁷ Department of Urology, University of Tübingen Medical School, Tübingen, Germany.
⁸ Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁹ Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK.
¹⁰ Academic Urology Unit, University of Sheffield, Sheffield, UK. Electronic address: m.g.cumberbatch@sheffield.ac.uk.

PMID: 31791622
DOI: 10.1016/j.eururo.2019.10.010

Abstract

Context: Non-visible haematuria (NVH) is a common finding and may indicate undiagnosed urological cancer. The optimal investigation of NVH is unclear, given the incidence of cancer and the public health implications of testing all individuals with this finding.

Objective: We review contemporary literature to determine the association of NVH with the diagnosis of bladder cancer (BC), upper tract urothelial carcinoma (UTUC), and kidney cancer (KC).

Evidence acquisition: A systematic review of original articles in English was completed in May 2019. Meta-analyses for the diagnostic accuracy of NVH and urine cytology were performed.

Evidence synthesis: We screened 1529 articles and selected 78 manuscripts that fulfilled our inclusion criteria for narrative synthesis. Forty manuscripts were eligible for a meta-analysis (reporting 19 193 persons). The likelihood of a urological cancer in patients with NVH increased with age (<1% in those aged <40yr), male sex, and cigarette smoking. Less than 1% of patients are found to have a urological cancer after a negative NVH evaluation. Cancer detection rates in individuals evaluated for NVH ranged from 0% to 16% for BC in 37 studies, 0% to 3.5% for UTUC in 30 studies, and 0% to 9.7% for KC in 29 studies. Substantial statistical heterogeneity was present for the meta-analysis of detection rates.

Conclusions: We present an up-to-date review of the association of NVH with the diagnosis of BC, UTUC, and KC. Individuals with dipstick positive haematuria aged ≥40yr, who have had potential precipitating causes excluded, should undergo an evaluation. Re-evaluation of patients with unremarkable initial investigations should be performed in high-risk patients or if new symptoms occur.

Patient summary: One in five people have microscopic traces of blood in their urine. This is an important indicator of urological cancer. Investigating all patients is uncomfortable and expensive. We evaluate the risk of cancer and estimate risks to groups of individuals.

Keywords: Bladder cancer; Kidney cancer; Microscopic haematuria; Non-visible haematuria; Upper tract urothelial cancer.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Carcinoma, Transitional Cell / complications
Carcinoma, Transitional Cell / diagnosis*
Hematuria / etiology
Humans
Kidney Neoplasms / complications
Kidney Neoplasms / diagnosis*
Ureteral Neoplasms / complications
Ureteral Neoplasms / diagnosis*
Urinary Bladder Neoplasms / complications
Urinary Bladder Neoplasms / diagnosis*