Women with Hematuria Facing Diagnosis and Referral Delay

HematuriaA new study by the Vanderbilt University Medical Center reveals that women with hematuria (blood in urine) were less than half as likely as men having the same issue to be referred to an urologist for additional tests.

Hematuria is considered as the first sign of bladder cancer and the American Urological Association (AUA) recommends that every person above the age of 35 with hematuria not due to a benign cause receive an evaluation by a urology specialist, which would include a cystoscopy and imaging of the urinary tract. The study says that women with hematuria face diagnosis and referral delay, which may explain why they are diagnosed with cancer in the later stage and have higher mortality rate than men. Funded by the National Cancer Institute (a division of the National Institutes of Health), the study stresses the need for better diagnosis and treatment for women with hematuria.

The study involved the review of the records of 9,211 Medicare beneficiaries diagnosed with hematuria from January 2009 to June 2010 and found that only 17 percent of females diagnosed with hematuria by their primary care provider were referred to an urologist for a diagnostic workup within 180 days while 39 percent of men were referred for the same issue. According to one of the researchers, this data suggest misdiagnosis and treatment of hematuria in women, as urinary tract infection is one of the major reasons why they are prone to more advanced stage bladder cancer during diagnosis.

According to the study, another reason for the disparity in referrals is clinical decision-making by physicians as they know that women are less likely to have bladder cancer than men. The findings suggest that physicians need to be more vigilant and stop missing opportunities to diagnose bladder cancer earlier in women. It is necessary for physicians to find a way to risk stratify women and determine whether or not they need a diagnostic workup.

When you visit a family practice physician with the signs of hematuria, the doctor will take a complete medical history to check for the risk factors and understand more about the symptoms. A physical examination is also performed to gather other information about possible signs of bladder cancer. If the physical examination produces abnormal results, the physician will conduct screening tests (for example, urinalysis, urine cytology) or refer you to a urologist for further tests and treatment.