Cystoscopy For Lower Urinary Tract Symptoms In Urogynecologic Practice: The Likelihood Of Finding Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 24 Feb 2008 - 0:00 PDT

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Evanston Northwestern Healthcare, Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern University Medical School, Evanston, IL, USA.

The authors evaluated the role of routine cystoscopy in detecting bladder cancer in women seen in a uro-gynecology practice and to determine whether microscopic hematuria is a reliable predictor of cancer risk. All women had lower urinary tract symptoms. The study population included 1,584 consecutive women undergoing office cystourethroscopy in a single urogynecology center between 1991 and 2001. The overall rate of biopsy-confirmed bladder cancer was 0.63%, including nine cases of transitional cell carcinoma and one superficial squamous cell carcinoma. Among women with initial microscopic hematuria, the rate of bladder cancer was 1.7%, significantly higher than 0.45% among those without hematuria (p = 0.03). However, in absolute terms, the majority of bladder cancer cases (60%; six of ten) presented with normal initial dipstick urinalysis.

These findings are in contrast to Messing, et.al1., who evaluated the role of routine urine dipsticks in detecting bladder cancer in asymptomatic men. Of 1,578 men, 258 had hematuria. 21 (6.4%) of the men with hematuria had bladder cancer on cystoscopy. The incidence of bladder cancer in men with hematuria seems much higher than in women, even though the women had lower urinary tract symptoms. It is unclear why hematuria seems to portend a higher risk of bladder cancer in men than women, although smoking history may play a role.

The findings in this study suggest that routine endoscopy of women without hematuria who have lower urinary tract symptoms is unlikely to detect bladder cancer, but if hematuria is identified, cystoscopy should be performed.

Goldberg RP, Sherman W, Sand PK

Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb 1
10.1007/s00192-007-0555-x

Reported by UroToday.com Contributing Editor David P. Wood, MD Professor and Chief of Urological Oncology Department of Urology University of Michigan Medical School Ann Arbor, MI

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