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Bladder Cancer May Not Present With Hematuria: Presented at AUGS

By Paula Moyer

SAN DIEGO, CA -- August 5, 2004 -- Women who present with irritative voiding symptoms should have their risk for bladder cancer assessed, even if they do not present with hematuria, according to a large study.

"We found that most patients with bladder cancer did not present with hematuria," said Roger P. Goldberg, MD, MPH, director of urogynecology research, Evanston Continence Center, Northwestern University Medical School, Evanston, Illinois. "The absence of hematuria, therefore, does not determine whether or not cystoscopy is necessary." He presented the findings here today at the 2004 American Urogynecologic Society/Society of Gynecologic Surgeons Joint Scientific Meeting.

He and coinvestigators conducted their study to determine whether hematuria would predict the risk of bladder cancer in women who are being evaluated for irritative voiding symptoms, and to know whether the presence or absence of this finding could be used to determine whether cystoscopy was necessary in the setting of a tertiary urogynecology practice.

They enrolled all 1,582 women who had been evaluated by office cystourethroscopy for irritative voiding symptoms at their centre from 1991-2001. All had undergone urethroscopy with a 0º lens, which was followed by 70º cystoscopy with distension to maximum cystometric capacity. Washings were sent for cytological evaluation in the presence of hematuria, bladder lesions or other factors that would be considered suspect for occult malignancy. In the presence of suspicious gross lesions, patients were referred to a urological oncologist.

The physicians completed a standardized data form after each study and incorporated the presenting signs, symptoms, and endoscopic findings. The investigators reviewed each patient's office records and relevant laboratory reports, and performed univariate (Student's t-test) and multivariate regression analyses.

Patients were an average of 60 years old and ranged from 17 to 95 years. Among them, 8.2% were active smokers, 47.5% had had prior pelvic surgery, and 10.8% had had a nonurologic malignancy.

Bladder cancer was diagnosed in 0.63% of the women, including 9 cases of transitional cell carcinoma and 1 case of superficial squamous cell cancer. Among the 9 transitional cell carcinoma lesions, biopsy showed that 8 were superficial and 1 was invasive. The investigators documented no cases of adenocarcinoma or metastatic lesions from other primary sites.

Among women with hematuria, the rate of cancer was 1.7%, compared to a cancer rate of 0.45% among those without hematuria (P =.03). Among the 10 bladder cancer cases, 6 had no hematuria.

The women with cancer were an average of 71.2 years old, compared to an average of 51.6 years for those without cancer (P =.01). The youngest woman with bladder cancer was 59 years old.

The investigators found that 30% of women with bladder cancer had prior nonurologic malignancy, compared to 11% of those without bladder cancer (P =.05). Among women with bladder cancer, 40% had microscopic or frank hematuria, compared to 14% of those who did not (P =.03). The vast majority of bladder cancer patients, 90%, had dysuria, compared to 34% of those without (P =.04). More bladder cancer patients, 40%, had bladder tenderness by transvaginal palpation, compared to 15% of those without cancer (P =.04). Bladder cancer patients and those without had similar rates of smoking (P =.34).

The analysis showed that age was the only independently predictive risk factor, Dr. Goldberg said.

Although cystourethroscopy is a comprehensive way to diagnose bladder cancer in patients with irritative voiding symptoms, physicians will still need to weigh its expense against its potential yield, reported Dr. Goldberg. However, factors other than the presence or absence of hematuria may be more helpful, he added, stressing that most of the cases of cancer diagnosed in this cohort were not associated with hematuria.


[Presentation title: Bladder Cancers Incidentally Diagnosed During the Evaluation of Irritative Voiding Symptoms: The Majority Do Not Present With Hematuria. Abstract P50]

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