THE ROLE OF CYSTOSCOPY IN THE EVALUATION OF HEMATURIA IN THE PRESENCE OF NORMAL RADIOLOGICAL AND MICROBIOLOGICAL WORK-UP

Objective: The etiology of microscopic andmacroscopic hematuria may range fromconditions posing minimal risk to the patient topotentially life-threatening conditions. There arecontraversial ideas about the evaluation ofhematuria. In this survey, we examined thenecessity of cystoscopy in patients withmicroscopic and macroscopic hematuria whowere radiologically and microbiologically normal.Methods: A total of 139 patients withmicroscopic or macroscopic hematuria who weremicrobiologically and radiologically normal andhad cystoscopy between 1991 and 2003 wereretrospectively analyzed. Routine history,physical examination, routine blood tests, urineanalysis, urine culture, a plain radiography,urinary system ultrasonography / intravenouspyelography, computerized tomography andtuberculosis tests, including ARB-Bactec wereunable to diagnose a pathology to identify thereason for hematuria, and cystoscopy wasperformed on all patients.R e su lts : Seventy five (53.9%) patients weremale and 64 (46.1%) were female. There wasno pathology in 86 (61.8%) patients indiagnostic cystoscopy whereas, 21(15.2%) hada papillary tumor and 16 (11.5%) had asuspicious lesion in the bladder that wasbiopsied. In 16 (11.5%) patients prostatichypertrophy was the only cystoscopic finding.According to the histopathological examination,15 (93.5%) of the suspicious lesion biopsieswere benign, but 1 (6.5%) patient hadcarcinoma in-situ. All of the papillary lesionswere reported as superficial transitional cellcarcinoma (TCCA). Overall, TCCA was detectedin 4(4.9%) and 18(31%) patients withmicroscopic and macroscopic hematuria,respectively. Irrespective of the type of thehematuria, none of the patients under 40 yearsof age were found to have bladder cancer.C o n c lu s io n : Our findings indicate that allpatients older than 40 years of age withmicroscopic and macroscopic hematuria shouldundergo a cystoscopy. The current study furthersuggests that patients younger than 40 years ofage with microscopic hematuria can only besafely followed up with non-invasive methods,without performing cystoscopy.K e y W o rd s : Microscopic, Macroscopic,Hematuria, Cystoscopy, Diagnosis