Is a patient-centred selective approach for investigation with CT urogram in patients with visible haematuria feasible and safe?

Objective: A standardised specific investigation protocol for the investigation of visible haematuria (VH) remains a debate. Our department was highlighted as a high user of computer tomography urogram (CTU) screening for VH in our region. A departmental audit identified 73% of VH referrals received a CTU between May and October 2018. A 4-year follow-up review of this cohort revealed no increase in missed cancers. Therefore, a selective approach for CTU screening was subsequently adopted based on patient risk factors of age, smoking status and persistent unexplained VH. We present a post-intervention study, performed to identify the impact of the selective approach on cancer detection rates. Patients and methods: Retrospective case-note review of all 2-week-wait referrals for VH from December 2022–June 2023. Data collection included the investigations utilised and the incidence of cancer detection. Results: In total, 360 patients (257 men, 103 women; median age 75 years, 45% smokers) underwent investigation for VH. 46% received a CTU compared to 73% pre-intervention. Cancer detection rates post-selective investigation remained consistent (18% bladder cancer, 1.4% renal cancer, 1.1% upper tract urothelial cancer) with pre-intervention rates and comparable to the literature. Conclusion: A selective approach to investigation with CTU in patients with VH appears safe and effective with no reduction in cancer detection rates. Level of evidence: 2c