One in 10 patients who present to the emergency department with visible hematuria may die within 3 months, new research from the United Kingdom has indicated. The WASHOUT study, presented at the European Association of Urology Congress (EAU26) in London, found that a scan administered within 48 hours could reduce this mortality risk (Abstract P1005). Scanning within 48 hours also ensured patients with cancer were diagnosed significantly faster. Approximately 25% of people who presented at the emergency department with visible hematuria had an underlying cancer, with the most common being bladder cancer, the study investigators reported.
Currently, patients who present to the emergency department with blood in their urine receive different care depending on which hospital they visit and which doctor they see. There are no guidelines built on real-world evidence for doctors to follow in cases of visible hematuria presenting to the emergency department. Based on global figures, half of patients (53%) receive a scan, one-third (35%) receive surgery, and other individuals are discharged home or admitted to the hospital for monitoring of symptoms, explained the investigators of the WASHOUT study.
The WASHOUT study drew on global data to show that rapid action is critical for better patient outcomes. The study investigators looked at data from more than 8,500 people across 380 hospitals worldwide and followed their clinical course for 90 days following their presentation to the emergency department with blood in their urine. Researchers also considered other factors that might have affected results, including age, frailty, and other underlying conditions.
Computed tomography or cystoscopy within 48 hours of arriving at the emergency department should determine the most appropriate next steps—such as whether the person should be treated for bladder cancer. Patients who did not receive investigative tests or appropriate treatment were 2.5% more likely to die within the next 3 months compared to those who did; these patients also spent more time in hospital and were more likely to be readmitted with the same symptoms within 3 months.
For patients with an underlying cancer, those who received investigative tests within the first 48 hours of admission were diagnosed within 1 day on average. In contrast, patients who were discharged without investigation faced a significantly longer wait, with diagnosis taking 3 weeks on average.
The research team is now taking steps to incorporate their findings into clinical guidelines.
Nikita R. Bhatt, MBBS, MCh, MMed, FRCS, a consultant urologist at St. Vincent’s University Hospital, Dublin, led the research presented at EAU26. She said: “This is the largest study exploring how we should treat people who present at [the emergency department] with blood in their urine. It’s a common problem affecting thousands of people around the world, and these patients are usually very unwell. But too often they fall through the gaps because [their symptoms] are not obviously tied to a specific disease. Our findings show how important it is that doctors take the necessary steps to identify the cause of the problem. For patients, the message is clear: if you have visible blood in your urine, don’t ignore it. See your doctor as soon as you can. If it doesn’t clear up, keep pushing until you find an answer. I hope our study gives patients the encouragement to do that.”
Joost Boormans, MD, PhD, a member of the EAU Scientific Congress Office and a urologist at the Erasmus University Medical Center, Rotterdam, said, “This is an important study highlighting the scale of the problem that emergency blood in the urine presents, both for patients and our already overstretched health-care systems. It’s difficult to draw strong conclusions about specific conditions because blood in the urine can be caused by many things, including cancer, and this group of patients is very diverse. But this study shows that timely investigative tests can accelerate diagnosis and reduce patients’ risk of readmission and long hospital stays, both being significantly high, as shown in the WASHOUT study. As urologists in emergency care, we should be aware of these numbers and do more to get an immediate diagnosis for people with blood in urine, to reduce the burden on our health-care systems and give our patients the best outcomes.”
