Women at risk of inadequate hematuria workup

New research presented at the American Urological Association (AUA) Annual Meeting suggests that elderly women are less likely than men to be referred for hematuria evaluation, and therefore less likely to receive a definitive urologic diagnosis. The findings are from a study by investigators from Nashville that was supported by the National Cancer Institute and described in abstract MP6-16 on Saturday, May 17 in Orlando, FL.

More than 9,000 Medicare A and B beneficiaries were included in the 5% sample identified by the authors has having been diagnosed with incident hematuria by a primary are provider during an outpatient visit between January 2009 and June 2010. The aim was to determine the association between gender, race, and timely and complete evaluation of hematuria. Patients who had a pre-existing diagnosis or discontinuous coverage were excluded.

Hematuria evaluation in the 180 days after diagnosis was judged as complete, incomplete or absent based on use of cystoscopy and abdomino-pelvic imaging. The researchers used generalized linear mixed models to determine the relationships between gender, race, and completeness of hematuria evaluation and adjusted for patient- and county-level covariates.

Hematuria evaluation was absent in 65% of the study patients, incomplete in 21% and complete in 14%. Women were less likely than men to be seen by a urologist, to undergo a diagnostic procedure or imaging, or to have a complete workup. Completeness of the workup was associated with the likelihood of a definitive urologic or renal diagnosis being rendered; an etiologic diagnosis was coded in 69% vs 34% vs 8% (P<0.001) and a malignancy diagnosed in 28% vs 2% vs 0.3% of evaluations that were complete, incomplete, or absent, respectively (P<0.001).

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