Diagnostic value of cystoscopy in the management of asymptomatic microscopic hematuri

Objective The cystoscopy has been one of initial diagnostic modalities in the evaluation of microscopic hematuria along with intravenous pyelography and urine cytology, but questions have been raised about its efficacy in the evaluation of asymptomatic microscopic hematuria. For the patients who visit outpatient clinics, the cystoscopy has been looked upon as rather invasive compared to other diagnostic methods. We tried to elucidate the actual diagnostic value of the cystoscopy in the evaluation of asymptomatic microscopic hematuria. Method We reviewed the results of cystoscopic exams of 213 patients(mean age: 49.7) who visited our hospital due to asymptomatic microscopic hematuria. For all of the 213 patients, no definite lesion that could explain the microscopic hematuria was detected by means of IVP, urine cytology, and other nephrologic evaluations. Results There were abnormal cystoscopic findings in 55 of the 213 patients who underwent cystoscopic exams. The lesions that are suspected to be directly related to microscopic hematuria were classified as 'the significant lesions' (31 patients, 17.6%): The lesions that cannot account for microscopic hematuria were classified as 'the insignificant lesions' (24 patients, 9.84%). 27 of the 31 patients with the significant lesions(85.2%) were over 50 years old, and further more, 3 patients who were diagnosed as bladder tumor by cystoscopy were over 60. Conclusions The cystoscopy should be utilized as initial diagnostic modality for asymptomatic microscopic hematuria to rule out any possibility of bladder tumor occurrence, and for the patients over 50 in age, its diagnostic value could be emphasized even more.