Abstract:

Objective: The etiology of microscopic and macroscopic hematuria may range from conditions posing minimal risk to the patient to potentially life-threatening conditions. There are contraversial ideas about the evaluation of hematuria. In this survey, we examined the necessity of cystoscopy in patients with microscopic and macroscopic hematuria who were radiologically and microbiologically normal. Methods: A total of 139 patients with microscopic or macroscopic hematuria who were microbiologically and radiologically normal and had cystoscopy between 1991 and 2003 were retrospectively analyzed. Routine history, physical examination, routine blood tests, urine analysis, urine culture, a plain radiography, urinary system ultrasonography / intravenous pyelography, computerized tomography and tuberculosis tests, including ARB-Bactec were unable to diagnose a pathology to identify the reason for hematuria, and cystoscopy was performed on all patients. R e su lts : Seventy five (53.9%) patients were male and 64 (46.1%) were female. There was no pathology in 86 (61.8%) patients in diagnostic cystoscopy whereas, 21(15.2%) had a papillary tumor and 16 (11.5%) had a suspicious lesion in the bladder that was biopsied. In 16 (11.5%) patients prostatic hypertrophy was the only cystoscopic finding. According to the histopathological examination, 15 (93.5%) of the suspicious lesion biopsies were benign, but 1 (6.5%) patient had carcinoma in-situ. All of the papillary lesions were reported as superficial transitional cell carcinoma (TCCA). Overall, TCCA was detected in 4(4.9%) and 18(31%) patients with microscopic and macroscopic hematuria, respectively. Irrespective of the type of the hematuria, none of the patients under 40 years of age were found to have bladder cancer. C o n c lu s io n : Our findings indicate that all patients older than 40 years of age with microscopic and macroscopic hematuria should undergo a cystoscopy. The current study further suggests that patients younger than 40 years of age with microscopic hematuria can only be safely followed up with non-invasive methods, without performing cystoscopy. K e y W o rd s : Microscopic, Macroscopic, Hematuria, Cystoscopy, Diagnosis

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