The diagnostic utility of cystoscopy in assessing patients with persistent microscopic abnormalities of urinalysis

Abstract

Abstract Background Microscopic abnormalities are common findings on routine urinalysis performed for various clinical reasons. As a small proportion of these may indicate an underlying malignancy, a large number of patients with these abnormalities are referred for further investigations, which includes a cystoscopy. We aim to investigate the diagnostic utility of cystoscopy in detecting malignancy in this group of patients. Methods A retrospective review of patients who underwent standard diagnostic workup for microscopic abnormalities of urinalysis (microscopic haematuria, sterile pyuria and bacteriuria) between January 2013 and December 2018 was performed. Patients with macroscopic haematuria, concurrent UTI, recent kidney stone passage, dysmorphic red cells, proteinuria and casts on urinalysis were excluded. Demographic information, age at diagnosis, smoking status and final diagnosis were extracted. Results In total, 552 patients identified. 58% of the patients are males (319 patients). The mean age was 61 years with 35% patients having a history of smoking. 94% of the patients underwent pre-cystoscopy imaging. Twelve (2%) patients had a final diagnosis of genitourinary malignancy. Out of the 12 patients diagnosed with malignancy, pre-cystoscopy imaging detected a bladder lesion in 11 (92%) patients. Conclusions The incidence of genitourinary malignancy in patients with persistent microscopic abnormalities of urinalysis is low at 2%. In our cohort, flexible cystoscopy demonstrated little additional diagnostic value with only 1 malignancy (0.2%) detected by flexible cystoscopy alone. Hence, we may have to reconsider our current threshold in investigating this group of patients.