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Letters

Haematuria clinics

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6934.980c (Published 09 April 1994) Cite this as: BMJ 1994;308:980
  1. A B Paul,
  2. G D Chisholm,
  3. D A Collie,
  4. S R Wild
  1. Department of Surgery/Urology, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU Department of Radiology.

    EDITOR, - In their editorial on haematuria clinics Philip Marazzi and Roger Gabriel1 comment on our study of a haematuria clinic2 and raise two points on which we would like to comment. Firstly, they comment on the apparent absence of urinary infections in 105 patients with prostatic hyperplasia and cancer, urolithiasis, and urethral stricture. We considered urinary tract infections in these patients to be secondary to those conditions and did not report them separately. In fact, seven of these patients had urinary tract infections proved on culture, and many had received antibiotic treatment from their general practitioner before coming to our clinic.

    Secondly, we agree that widespread dipstick testing of urine in general practice can overload haematuria clinics such as ours. We studied the activity of this clinic for the two months July and August 1993 (that is, two years after the end of the period reported in our previous study). In this time 28 patients attended the clinic. Eight (29%) had microscopic haematuria, compared with 53 (17%) of 304 patients in the earlier period. Not surprisingly, the proportion with no demonstrable pathological finding on investigation was higher in the second period. In our earlier study we reached no diagnosis in 61 (20%) of the 304 patients, while in the second period this proportion had risen to 13 (46%) of the 28 (P<0.01, X2 test). The aim of our haematuria clinic was to expedite the investigation of haematuria, but this aim had suffered in the two years between the studies. In our first study the mean delay between referral and the clinic appointment was 23 (SD 14.6) days; by July 1993 this had risen to 40 (27.3) days (P<0.001, Mann-Whitney test).

    As Marazzi and Gabriel point out, the correct use of haematuria clinics demands selective referral. Our present practice is to arrange ultrasonography on an outpatient basis for patients with microscopic haematuria and to examine its results before considering the merits of cystoscopy in each case. The “fast track” of our haematuria clinic is reserved for patients with frank haematuria.

    References

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