Prevalence and Predictors of Bladder Cancer among Patients with Asymptomatic Microhematuria: A Single Centre Retrospective Study

Abstract

Bladder tumours can remain asymptomatic and progressed into advanced disease before diagnosis. Most data from European countries suggests revealed prevalence of 2.8-4.8% bladder tumor detected from microhematuria workup. However, there is paucity of study done in Asian populations. It is certainly beneficial to study on local population and identify factors associated with bladder tumor in asymptomatic microhematuria. This study aims to report the incidence of bladder tumour from asymptomatic patients with microhematuria in Kedah General Hospital who underwent flexible cystoscopy. We also aim to study other probable factors for bladder tumors and scrutinize the use of other diagnostic tools (repeat urinalysis, ultrasound, contrasted CT) to aid in early detection of bladder tumor. This retrospective study reviewed patients who had cystoscopy performed to detect bladder tumours, who initially presented with asymptomatic microhematuria. Clinicopathological variables studied included patient age, gender, co-morbidity, smoker, family history of bladder tumor, flexible cystoscopy, ultrasound, contrasted CT and histopathological assessment of the resected specimen. A total of 206 patients who initially referred for microhematuria, underwent cystoscopy from January 2022 until April 2024. Total 16 patients (7.7%) had bladder tumor. Most of the bladder tumor detected from age 60 an above (92%), while those who aged below 40 had no tumor detected. Among them, 92.3% had ultrasound and/or contrasted CT, compared to 7.6% (1/13) who had cystoscopy alone. We noticed there is higher risk for tumor detection in patient who had positive findings of tumor from urine cytology, ultrasound and CT. Male are at higher risk of bladder tumor detection compared to female (3:1). The prevalence of bladder tumour in asymptomatic microhematuria in Kedah General Hospital is 7.7%, which is an underestimated risks for bladder tumor in primary care setting. Patients who are asymptomatic, but with risks factors, should be counsel for repeat urinalysis with imaging (ultrasound/CT) and flexible cystoscopy. In addition,

Keywords Microhematuria, bladder tumor, flexible cystoscopy.