Pilot Study

A pilot of 824 patients was successfully run as a service evaluation in 7 hospitals in the South of England and is now completed. The following centres were involved:

  • Sinan Khadhouri (Royal Devon and Exeter Hospital)
  • Catherine Miller (Torbay Hospital)
  • Nick Campain (Musgrove Park Hospital, Taunton)
  • Arvinda Chippagari (Royal United Hospitals Bath)
  • Madeline Moore (Plymouth Hospital)
  • Niyati Lobo (Royal Sussex County Hospital, Brighton)
  • Sian Parsons (Great Western Hospital, Swindon)

This confirmed the feasibility of the project and helped to finalise the design of the main phase of the study which is being rolled out now.

Introduction and Objective

This analysis aims to provide an up-to-date overview of haematuria investigations and subsequent urological cancer detection rate. This is in light of recently updated NICE (National Institute for Clinical Excellence) referral guidelines for suspected bladder cancer in June 2015 that aimed to standardise referrals and facilitate early detection of urological cancer.


Prospective data for 824 patients were collected from 7 hospitals in the south of England for all suspected cancer referrals presenting with haematuria. Those with previous urological malignancy were excluded. Individual hospital protocols for such referrals were also noted.


491 men and 333 women with a median age of 67 were included in the study. 301 (36.5%) patients had non-visible haematuria (NVH); 523 (63.5%) had visible haematuria (VH). All hospitals had cystoscopy and ultrasound (USS) as first line investigations  (one hospital used abdominal X-ray alongside USS), and a mixture of CT, intravenous urogram (IVU) and ureterorenoscopy (URS) as second line.

The overall prevalence of urological malignancy was 12.2% (10.4% bladder, 0.6% ureteric/ renal TCC, 1.2% renal); which was 16.4% of the VH group and 5.0% of the NVH group. 85% of malignancies presented with VH. Differences in prevalence existed in sex and age groups. Bladder cancer was found in 5 patients younger than 45 years, 4 of whom presented with VH (an age criteria of 45 or older is recommended in the referral guidelines). A higher percentage of patients with malignancy had a smoking history vs. non-smokers. Stones accounted for 6.7% of presentations.

95.5% of all malignancies and 94.9% of all pathology were diagnosed following an abnormal flexible cystoscopy and/or USS alone. One renal malignancy and 4 upper tract TCCs that were diagnosed with second line investigations had a normal USS.

The prevalence of urological malignancy shown in this analysis compares to previous studies. Second line investigations for upper tract imaging are variable amongst different hospitals. The majority of malignancies were diagnosed following abnormal first line investigations with USS for upper tract imaging. Patients with malignancy were more likely to have a smoking history and present with VH.