Investigation of two week wait referred haematuria patients in the UK: A national survey

Abstract

Aim: To analyse current UK practice for investigation of patients with visible haematuria (VH) or non-visible haematuria (NVH) who meet referral criteria according to National Institute of Clinical Excellence referral guidelines for suspected cancer. Patients and methods: Questionnaires were sent to 131 trusts. Data collected included demographics, conformity with NICE improving outcomes in urological cancer guidelines, standard first line investigations into VH and NVH and criteria for second line investigations. Results: Seventy-two trusts (55%) responded from 15 deaneries including 48 cancer centres. Almost two-thirds (63.9%) provide a one-stop service. First line investigations into VH varied considerably: 82% of trusts undertake urine tests (cytology 43.0%); three-quarters perform blood tests (prostate-specific antigen 54.2%); all conduct varying radiological imaging of the upper tracts; 95.8% of patients had flexible cystoscopy. Forty per cent of trusts’ first line investigations differ for NVH. Triple phase computed tomography-urogram is not routinely undertaken. Of the trusts, 55.5% perform second line investigations for VH and 55.5% for recurrent VH including computed tomography-urogram or retrograde studies; 20.5% perform non-contrast helical computed tomography scan of the kidneys, ureters and bladder or urine cytology for NVH if the history is indicative. Conclusion: Across trusts, there are wide variations in the regimes for investigation of haematuria. Development of an evidence based guideline to standardise practice across the National Health Service for haematuria referrals is required to abolish the postcode lottery system.