Factors affecting the timeliness and adequacy of haematuria assessment in bladder cancer: a systematic review

Objectives To review the literature to identify factors affecting haematuria assessment in bladder cancer. Methods We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications indexed in EMBASE and Medline (PubMed) in March 2016 were searched, using the keywords 'hematuria', 'urinary bladder neoplasm(s)' and 'bladder tumor'. Studies evaluating the timeliness and adequacy of haematuria assessment in the context of bladder cancer were included. Exclusion criteria included age <18 years, animal studies and non-English articles. Results Following our search strategy, a total of 17 articles were included in our study. All 17 studies commented on gender, with female gender associated with delayed and inadequate haematuria evaluation. Women waited longer than men for urological review (three studies) and bladder cancer diagnosis (three studies). Women were also less likely to be referred to urology (two studies), receive imaging (three studies) or have cystoscopy (two studies). In all, 10 studies commented on age, with the impression that advancing age is associated with a more thorough assessment. Smokers and those with microscopic haematuria appear to undergo a less thorough evaluation. Conclusion Female gender is associated with sub-optimal haematuria evaluation, while older patients are evaluated more thoroughly. Smokers paradoxically undergo less comprehensive assessment. Further research on the impact of other factors is required.