Introduction: Presentation with non-visible haematuria (NVH) is associated with a small risk of upper urinary-tract transitional cell carcinoma (UUT-TCC), though there is little consensus among the urological community on the investigation of NVH, especially with regards to upper-tract imaging. For patients referred under 60 years old where the risk is even smaller, clinicians are faced with a dilemma of whether to routinely undertake CT urography, exposing patients to its associated risks versus potentially missing pathology. We present our 10-year experience of UUT-TCC cases and their presentation.
Methods: We reviewed the urological cancer multidisciplinary team (MDT) database for all cases of UUT-TCC diagnosed during a 10-year period between 2008 and 2018 at one large urological centre in the United Kingdom. UUT-TCC was diagnosed on the basis of MDT consensus from the radiological and histological findings. Data collected included the age at presentation, presenting complaint, the upper tract imaging modality utilised and the histologically confirmed site of malignancy.
Results: 119 patients were diagnosed with UUT-TCC during the period of interest at our centre; 64 (53.8%) were male, while 55 (46.2%) were female. 70 patients (58.8%) presented with visible haematuria (VH), 6 (5.0%) presented with NVH, while UUT-TCC was diagnosed incidentally in 43 patients (36.1%). The median age at diagnosis was 75 years (range 42 – 93) and 8 patients (6.7%) were diagnosed below the age of 60, of whom only one patient (0.8%) had presented with NVH; thus not meeting the National Institute for Health and Care Excellence (NICE) age criteria for urgent referral for NVH. CT urography was undertaken for all 6 patients presenting with NVH in the first instance which demonstrated hydronephrosis in 4, a renal parenchymal lesion in one and a renal pelvic filling defect in another; most if not all of these could have been identifiable on ultrasonography. Only one patient presented as TCC of the pelviureteric junction (PUJ) on imaging, which was subsequently confirmed histologically.
Conclusions: NVH is a rare presenting complaint of UUT-TCC, especially in those under the age of 60. Our 10-year experience suggests that ultrasonography is likely a safe and accurate first-line imaging modality for younger patients presenting with NVH, though larger studies are needed to further evaluate this.
Source of Funding: This project did not receive any funding from any public, commercial or not-for-profit organisation.