Women with isolated acute cystitis and macroscopic haematuria. Is further investigation needed?
DOI:
https://doi.org/10.2340/sju.v60.44702Keywords:
Computed tomography urography, cystitis, cystoscopy, female, haematuria, standardised care pathway, urinary tract infection, urological malignancy, womanAbstract
Objective: To determine if women aged 50–70 years with a single episode of isolated acute haemorrhagic cystitis have a significantly lower risk of developing urological cancers, potentially indicating that further evaluation for macroscopic haematuria may be unnecessary.
Materials and methods: A retrospective study was conducted on all women assessed for macroscopic haematuria at two participating centres in Sweden between 2020 and 2022. The standard evaluation included computed tomography urography and cystoscopy. Patients were divided into two groups: AHG (acute haemorrhagic cystitis group), which was defined by the presence of macroscopic haematuria and symptoms resembling acute cystitis (dysuria, frequency or urgency), and non-AHG (non-acute haemorrhagic cystitis group), consisting of women with chronic, complicated or recurrent irritative symptoms or no cystitis-like symptoms at all. The characteristics of the women and their tumours were documented.
Results: A total of 1,084 women were evaluated for macroscopic haematuria. The median age was 67 years, with 652 women (60%) aged 50–70. Urological malignancies were detected in 71 women (7%). In the younger group, the AHG had a low cumulative cancer incidence (1%), whereas the non-AHG had a significantly higher rate (10%), P < 0.001. Asymptomatic haematuria showed the highest cumulative cancer incidence (11%). A multivariable Cox regression analysis (for all patients in the study) indicated that women in non-AHG have a seven-fold higher risk of developing urological cancer over time than women in AHG (hazard ratio [HR]: 7.19; 95% confidence interval [CI]: 3.64–14.21; P < 0.001).
Conclusion: Women aged 50–70 years with isolated acute haemorrhagic cystitis have a significantly low risk of urological malignancies, indicating that invasive investigations, such as cystoscopy and computed tomography urography, may not always be necessary. Nonetheless, further large-scale prospective studies are needed to validate these findings.
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Copyright (c) 2025 Rula Hassan, Rasmus Ljungstedt, Elsa Ågren, Salome Olsson, Emad Sabir, Suleiman Abuhasanein
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