Clinical Features and Efficacy of Diagnostic Methods in Adults with Asymptomatic Microscopic Hematuria

Lee, Gyu Gwang; Cheon, Sang Hyeon; Park, Ro Jung

Abstract

PURPOSE: Asymptomatic microscopic hematuria is a difficult problem faced at the offices of many urologists. This study was aimed at evaluating the ability for the detection of significant lesions, according to the grade of microscopic hematuria and the comparison of various diagnostic modalities.
MATERIALS AND METHODS
Between March 1999 and December 2003, 755 adult patients that visited our hospital due to asymptomatic microscopic hematuria were examined according to the diagnostic algorithm. The male-to-female ratio was approximately 1:1.1 (366:389). Microscopic hematuria was divided into five grades. Lesions found at evaluation were categorized as either highly or moderately significant or insignificant lesions.
RESULTS
221 (29.3%) out of 755 patients were found to have lesions during evaluation. Of these 221 patients, 33 with highly significant lesions, including 4 urologic malignancies, 127 with moderately significant lesions and 61 with insignificant lesions, were detected. Correlation was shown between the degree of microscopic hematuria and the likelihood of detecting significant urologic diseases. The sensitivity and specificity for the detection of significant lesions by urine cytology, ultrasonography (USG), intravenous pyelography (IVP), cystoscopy, computed tomography (CT) and the combination of USG and IVP were 2.5/96.3%, 35.6/96.5%, 34.7/ 96.0%, 7.4/97.7%, 100/98.2% and 44.8/94.8%, respectively.
CONCLUSIONS
The combination of USG and IVP for the detection of significant lesions at the initial examination was more beneficial than USG or IVP. Cystoscopy and CT are necessary additional diagnostic modalities for patients with abnormal findings at the initial examination and for those patients with asymptomatic microscopic hematuria who are at high risk.