Predictors of delay to cystoscopy and adequacy of investigations in patients with haematuria.

Abstract

To identify factors that impact on the timeliness and adequacy of haematuria evaluation. We undertook a retrospective cohort study identifying patients who underwent cystoscopy for investigation of haematuria at our institution between 1 January 2015 and 31 December 2015. Data on patient demographics, smoking status, anticoagulation, type of haematuria and referring clinician were collected. Exclusion criteria included patient age <18 years, known history of bladder/urinary tract/renal cancer, cystoscopy for indications other than haematuria and unknown date of urology consultation. Primary outcome measures were: i) time from general practitioner (GP) referral to urology consultation, ii) time from urology consultation to cystoscopy, and iii) receipt of investigations in the 180 days prior to cystoscopy. Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes. Over the study period, 305 eligible cases (225 men, 80 women) were identified, of which 196 (64%) were referred by a GP. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time to urology consultation was 65 days for women and 33.5 days for men (P = 0.020). However, the observed difference between men and women was no longer statistically significant on multivariable regression, with the only independent predictors of a shorter interval being visible haematuria and imaging suspicious for cancer. Anticoagulated patients were more likely to have imaging studies, in particular renal tract ultrasonography (P = 0.006), while only 61% of patients with visible haematuria received imaging. No significant differences in recent investigations between genders were observed. Gender is not a significant predictor of delayed haematuria assessment or receipt of recent investigations. Anticoagulated patients are more likely to receive imaging than patients without anticoagulation and patients with visible haematuria are not adequately imaged. Improved clinician and public education is required to ensure that all patients are evaluated appropriately.