Incidence of recurrent frank hematuria and urological cancers: prospective 6.9 years of followup

Purpose: The majority of patients presenting with frank hematuria have no diagnosis. There is a paucity of literature on the recurrence of frank hematuria and the incidence of urological cancers in these patients, and this study addresses both issues. Materials and Methods: We performed a prospective cohort study of 578 consecutive patients referred with frank hematuria between 1999 and 2001 who underwent full investigations with a mean followup of 6.9 years. The primary outcome measure was the probability of frank hematuria recurrence after the initial negative investigations and the incidence of urological cancers in these patients. Results: Diagnosis was made in 206 (35.6%) patients at initial presentation. Diagnosis was not made at initial presentation in the remaining 372 (64.4%) patients, of whom 81 died without a diagnosis during followup (32 within 2 years of presentation). A total of 81 patients (21.8%) with no diagnosis died during the followup period (32 within 2 years of the investigations). A questionnaire was mailed to the remaining 291 patients and 202 (69.4%) responded. Of the responders 41 (20.3%) reported frank hematuria recurrence (single episode in 10 and multiple episodes in 31). A significant urological diagnosis was made upon repeat evaluation in 21 (10.4%) patients which included urological malignancy in 4 (2%). Conclusions: Approximately 80% of cases cleared by initial investigation remained clear and 9.8% with frank hematuria recurrence were diagnosed with a urological malignancy. Frank hematuria recurrence requires vigilance and repeat investigations as appropriate.