According to their individual GFR, patients were split into three groups: normal renal function, moderately impaired renal function, and severely impaired renal function. All patients had cystoscopy, cytology, uCyt+ (Diagnocure), UroVysion (Vysis) and NMP22 (Matritech). In 85.1% of patients, cystoscopy was regarded as normal. The highest false-positive rates were seen for urine cytology results. Patients with impaired renal function showed higher false-positive rates for NMP22 as well as uCyt and UroVysion. The authors concluded that urine-based tests for the diagnosis of urothelial cancer of the bladder must be interpreted with caution in patients with impaired renal function.
The performance of urine-based tests is with mixed results, and no general recommendation can be made (although they are used in many instances). One solution could be to perform intensive diagnostic work-up in patients with risk factors for urothelial cancer such as increasing age, smoking status, gross hematuria, and positive cytology. It is a known fact that impaired renal function results in higher rates of false-positive urine cytology. However, it may be better to perform one unnecessary cystoscopy rather than missing one tumor. Moreover, how invasive is a flexible cystoscopy?
Presented by M. Witstruk, et al. at the Deutsche Gesellschaft für Urologie (DGU) - 63rd Annual Congress - September 14 - 17, 2011 - Congress Center - Hamburg, Germany
Reported for UroToday by Christian Doehn, MD, PhD, Urologikum Lubeck, Lubeck, Germany.
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