Clinical comparison of hematuria degree and pathology according to the AUA bladder cancer risk classification

Abstract

Aim: To determine the relationship between microhematuria level and bladder cancer diagnosis and staging. Methods: A total of 452 patients who visited the Urology Clinic of the Faculty of Medicine of Afyonkarahisar Health Sciences University between 2017 and 2024 with complaints such as hematuria, dysuria, and suprapubic pain, and who underwent TUR-M surgery due to suspected bladder cancer-based on laboratory and imaging methods, were included. The pathology results confirmed the diagnosis of bladder cancer. In addition to demographic information such as age, gender, number of cigarettes smoked, and the presence of other risk factors for urothelial carcinoma (UC), data on hematuria levels, tumor stage and grade, American Urological Association (AUA) risk classification, microhematuria risk stratification, and pathological findings including lymphovascular invasion (LVI) and perineural invasion (PNI) were also recorded. Results: Patients with more than 25 erythrocytes per microliter of urine or those with macroscopic hematuria had higher rates (42.1%) of additional risk factors for UC than other groups (p=0.040). The rate of high-stage and high-grade tumors was significantly higher in the group with >25 erythrocytes per microliter of urine compared to the other groups (p < 0.001, p < 0.001). When analyzing the AUA risk classification across the groups, 42 (32.8%) patients in the 3-10 erythrocyte group and 21 (35%) patients in the 10-25 erythrocyte group were classified as high risk. In contrast, 152 (64.7%) patients in the >25 erythrocyte group were classified as high risk, a rate significantly higher than in the other groups (p < 0.001). Conclusions: Hematuria level is associated with tumor grade, tumor stage, and muscle invasion in bladder cancer. Given this association, it is crucial to carefully assess hematuria levels and the microhematuria risk classifications of patients.