Open AccessPatients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system
Author(s) -
Faysal A. Yafi,
Armen Aprikian,
Simon Tanguay,
Wassim Kassouf
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.589
Subject(s) - medicine , referral , urinalysis , microscopic hematuria , gross hematuria , family medicine , respondent , primary care , asymptomatic , general surgery , urinary system , surgery , proteinuria , political science , law , kidney
Background: Hematuria is one of the most common findings onurinalysis in patients encountered by primary care physicians. Inmany instances it can also be the first presentation of a serious urologicalproblem. As such, we sought to evaluate current practicesadopted by primary care physicians in the workup and screeningof hematuria.Methods: Questionnaires were mailed to all registered primary carephysicians across Quebec. Questions covered each physician’spersonal approach to men and postmenopausal women with painlessgross hematuria or with asymptomatic microscopic hematuria,as well as screening techniques, general knowledge with regardsto urine collection and sampling, and referral patterns.Results: Of the surveys mailed, 599 were returned. Annual routinescreening urinalysis on all adult male and female patients wasperformed by 47% of respondents, regardless of age or risk factors.Of all the respondents, 95% stated microscopic hematuria wasassociated with bladder cancer. However, in an older male withpainless gross hematuria, only 64% of respondents recommendedfurther evaluation by urology. On the other hand, in a postmenopausalwoman with 2 consecutive events of significant microscopichematuria, only 48.6% recommended referral to urology. Findingswere not associated with the gender of the respondent, experienceor geographic location of practice (urban vs. rural).Interpretation: There seems to be reluctance amongst primary carephysicians to refer patients with gross or significant microscopichematuria to urology for further investigation. A higher level ofsuspicion and further education should be implemented to detectserious conditions and to offer earlier intervention when possible.