Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines

Bernd J. Schmitz-Dräger, Eva C. Kuckuck, Tahlita C M Zuiverloon, Ellen C. Zwarthoff, Amanda Saltzman, Abhishek Srivastava, M'Liss A. Hudson, Roland Seiler, Tilmann Todenhöfer, Antonia Vlahou, H. Barton Grossman, Mark P. Schoenberg, Marta Sanchez-Carbayo, Lenuta A. Brünn, Bas W G van Rhijn, Peter J. Goebell, Ashish M. Kamat, Morgan Roupret, Sharokh F. Shariat, Lambertus A. Kiemeney

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Rationale Assessment of patients with asymptomatic microhematuria (aMh) has been a challenge to urologists for decades. The aMh is a condition with a high prevalence in the general population and also an established diagnostic indicator of bladder cancer. Acknowledging aMh needs to be assessed within a complex context, multiple guidelines have been developed to identify individuals at high risk of being diagnosed with bladder cancer. Material & Methods This structured review and consensus of the International Bladder Cancer Network (IBCN) identified and examined 9 major guidelines. These recommendations are partly based on findings from a long-term study on the effects of home dipstick testing, but also on the assumption that early detection of malignancy might be beneficial. Results Despite similar designs, these guidelines differ in a variety of parameters including definition of aMh, rating of risks, use of imaging modalities, and the role of urine cytology. In addition, recommendations for further follow-up after negative initial assessment are controversial. In this review, different aspects for aMh assessment are analyzed based upon the evidence currently available. Discussion We question whether adherence to the complicated algorithms as recommended by most guidelines is practical for routine use. Based upon a consensus, the authors postulate a need for better tools. New concepts for risk assessment permitting improved risk stratification and prepone cystoscopy before refined imaging procedures (computed tomography scan and magnetic resonance imaging) are suggested.

Original languageEnglish (US)
Pages (from-to)437-451
Number of pages15
JournalUrologic Oncology: Seminars and Original Investigations
Volume34
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Urinary Bladder Neoplasms
Guidelines
Cystoscopy
Cell Biology
Tomography
Magnetic Resonance Imaging
Urine
Population
Neoplasms

Keywords

  • Bladder cancer
  • Diagnosis
  • Disease management
  • Guidelines
  • Microhematuria
  • Urine cytology
  • Urine markers

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Schmitz-Dräger, B. J., Kuckuck, E. C., Zuiverloon, T. C. M., Zwarthoff, E. C., Saltzman, A., Srivastava, A., ... Kiemeney, L. A. (2016). Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines. Urologic Oncology: Seminars and Original Investigations, 34(10), 437-451. https://doi.org/10.1016/j.urolonc.2016.05.030

Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines. / Schmitz-Dräger, Bernd J.; Kuckuck, Eva C.; Zuiverloon, Tahlita C M; Zwarthoff, Ellen C.; Saltzman, Amanda; Srivastava, Abhishek; Hudson, M'Liss A.; Seiler, Roland; Todenhöfer, Tilmann; Vlahou, Antonia; Grossman, H. Barton; Schoenberg, Mark P.; Sanchez-Carbayo, Marta; Brünn, Lenuta A.; van Rhijn, Bas W G; Goebell, Peter J.; Kamat, Ashish M.; Roupret, Morgan; Shariat, Sharokh F.; Kiemeney, Lambertus A.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 34, No. 10, 01.10.2016, p. 437-451.

Research output: Contribution to journalReview article

Schmitz-Dräger, BJ, Kuckuck, EC, Zuiverloon, TCM, Zwarthoff, EC, Saltzman, A, Srivastava, A, Hudson, MLA, Seiler, R, Todenhöfer, T, Vlahou, A, Grossman, HB, Schoenberg, MP, Sanchez-Carbayo, M, Brünn, LA, van Rhijn, BWG, Goebell, PJ, Kamat, AM, Roupret, M, Shariat, SF & Kiemeney, LA 2016, 'Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines', Urologic Oncology: Seminars and Original Investigations, vol. 34, no. 10, pp. 437-451. https://doi.org/10.1016/j.urolonc.2016.05.030
Schmitz-Dräger, Bernd J. ; Kuckuck, Eva C. ; Zuiverloon, Tahlita C M ; Zwarthoff, Ellen C. ; Saltzman, Amanda ; Srivastava, Abhishek ; Hudson, M'Liss A. ; Seiler, Roland ; Todenhöfer, Tilmann ; Vlahou, Antonia ; Grossman, H. Barton ; Schoenberg, Mark P. ; Sanchez-Carbayo, Marta ; Brünn, Lenuta A. ; van Rhijn, Bas W G ; Goebell, Peter J. ; Kamat, Ashish M. ; Roupret, Morgan ; Shariat, Sharokh F. ; Kiemeney, Lambertus A. / Microhematuria assessment an IBCN consensus—Based upon a critical review of current guidelines. In: Urologic Oncology: Seminars and Original Investigations. 2016 ; Vol. 34, No. 10. pp. 437-451.
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AU - Zwarthoff, Ellen C.

AU - Saltzman, Amanda

AU - Srivastava, Abhishek

AU - Hudson, M'Liss A.

AU - Seiler, Roland

AU - Todenhöfer, Tilmann

AU - Vlahou, Antonia

AU - Grossman, H. Barton

AU - Schoenberg, Mark P.

AU - Sanchez-Carbayo, Marta

AU - Brünn, Lenuta A.

AU - van Rhijn, Bas W G

AU - Goebell, Peter J.

AU - Kamat, Ashish M.

AU - Roupret, Morgan

AU - Shariat, Sharokh F.

AU - Kiemeney, Lambertus A.

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N2 - Rationale Assessment of patients with asymptomatic microhematuria (aMh) has been a challenge to urologists for decades. The aMh is a condition with a high prevalence in the general population and also an established diagnostic indicator of bladder cancer. Acknowledging aMh needs to be assessed within a complex context, multiple guidelines have been developed to identify individuals at high risk of being diagnosed with bladder cancer. Material & Methods This structured review and consensus of the International Bladder Cancer Network (IBCN) identified and examined 9 major guidelines. These recommendations are partly based on findings from a long-term study on the effects of home dipstick testing, but also on the assumption that early detection of malignancy might be beneficial. Results Despite similar designs, these guidelines differ in a variety of parameters including definition of aMh, rating of risks, use of imaging modalities, and the role of urine cytology. In addition, recommendations for further follow-up after negative initial assessment are controversial. In this review, different aspects for aMh assessment are analyzed based upon the evidence currently available. Discussion We question whether adherence to the complicated algorithms as recommended by most guidelines is practical for routine use. Based upon a consensus, the authors postulate a need for better tools. New concepts for risk assessment permitting improved risk stratification and prepone cystoscopy before refined imaging procedures (computed tomography scan and magnetic resonance imaging) are suggested.

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