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Microscopic hematuria and urothelial malignancy.

Kotb and Attia noted that "cystoscopy is highly recommended for young adult men, with significant levels of microscopic hematuria, due to the 20% incidence rate of associated urological malignancy." (1) In fact, there are several etiologies of microscopic hematuria. (2) Using cystoscopy might be useful, however, it is questionable due to its invasiveness. There may be some useful additional tests for the differential diagnosis of other causes of hematuria, such as urine biochemistry and urine red cell morphology study. As noted by McDonald and colleagues, the use of urine cytology should be considered before deciding to use cystoscopy to investigate a patient with hematuria. (3) A recent medical economics study concluded that "for low-risk patients the use of immediate cystoscopy could be avoided if cystoscopy were used for follow-up patients with a negative initial test using tumour markers and/or cytology." (4)

Competing interests: Authors declare no competing financial or personal interests.

References

(1.) Kotb AF, Attia D. High-grade microscopic hematuria in adult men can predict urothelial malignancy. Can Urol Assoc J 2014;8:E481-4. http://dx.doi.org/10.5489/cuaj.1746

(2.) Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician 2013;88:747-54.

(3.) McDonald MM, Swagerty D, Wetzel L. Assessment of microscopic hematuria in adults. Am Fam Physician 2006;73:1748-54.

(4.) Rodgers M, Nixon J, Hempel S, et al. Diagnostic tests and algorithms used in the investigation of haematuria: Systematic reviews and economic evaluation. Health Teehnol Assess 2006;10:iii-iv, xi-259.

Author response: Microscopic hematuria and urothelial malignancy

Ahmad M. Beltagy, MD; Doaa Attia, MD; Ahmed Fouad Kotb, MD

Urology Department, Faculty of Medicare, Alexandria University, Alexandria, Egypt

http://dx.doi.org/10.5489/cuaj.2577

Published online December 15, 2014.

Correspondence: Dr. Sim Sai Tin, Medical Center, Shantou, China; simsaitin@gmail.com

We would like to thank Tin and colleagues (1) for their interest in our publication. (2) There are many etiologies of microscopic hematuria (MH), other than urinary tract malignancy; however, the presence of dysmorphic red blood cells, proteinuria, casts and/or renal insufficiency or any other clinical indicator suspicious for renal parenchymal disease warrants concurrent nephrologic and urological workup. (3)

As mentioned in our study, (2) all patients were initially investigated by urine cytology, which were all negative. Similarly, Feifer and colleagues (4) found that for patients with MH, voided urine cytology added a significant cost without any diagnostic benefit in the workup for low-risk patients. In their study, it was shown that of 200 patients, (8) (4%) had low-grade urothelial bladder cancer via cystoscopy (Ta or T1 tumours). Of these 8 patients, the cytology was negative in 4 patients and atypical in 4. These cases were asymptomatic contrary to our patients with lower urinary tract symptoms. The economic study referred to by Tin and colleagues was a retrospective study depending on data collection of cases presented in 2003 and 2004 and still confirmed the role of cystoscopy, following negative cytology.

We found that 20% of our cases presented with MH had negative urine cytology, negative findings in multiphasic computed tomography, and positive cystoscopic finding--this number of close to those presenting with gross hematuria. This confirms the importance of cystoscopy as an initial diagnostic tool for high-grade MH.

Competing interests: Authors declare no competing financial or personal interests.

References

(1.) Tin SS, Wiwanitkit V. Microscopic hematuria and urothelial malignancy [letter]. Can Urol Assoe J 2014;8:395. http://dx.doi. org/10.5489/cuaj.2440

(2.) Kotb AF, Attia D. High-grade microscopic hematuria in adult men can predict urothelial malignancy. Can Urol Assoe J 2014;8:E4814. http://dx.doi.org/10.5489/cuaj.1746

(3.) Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow up of asymptomatic microhematuria (AMH) in adults: AUA guidelines. J Urol 2012;188(6 Suppl):2473-81. http://dx.doi. org/10.1016/j.juro.2012.09.078

(4.) Feifer AH, Steinberg J, Tanguay S, et al. Utility of urine cytology in the workup of asymptomatic microscopic hematuria in low risk patients. Urology 2010;75:1278-82. http://dx.doi. org/10.1016/j.urology.2009.09.091

Sim Sai Tin, MD; * Viroj Wiwanitkit, MDf

* Medical Center, Shantou, China; Wishing professor, Hainan Medical University, China

http://dx.doi.org/10.5489/cuaj.2440

Published online December 15, 2014.

Author response: Microscopic hematuria and urothelial malignancy

Correspondence: Dr. Ahmed Fouad Kotb, Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; drahmedfali@gmail.com
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Title Annotation:Letters
Author:Tin, Sim Sai; Wiwanitkit, Viroj
Publication:Canadian Urological Association Journal (CUAJ)
Article Type:Report
Date:Dec 1, 2014
Words:744
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