Same day diagnostic service for new cases of haematuria - a District General Hospital experience

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Abstract
To describe the running of a special haematuria diagnostic service which catered for a flexible cystoscopy on the same day as the first clinical visit. The impact of this service especially with regard to the timing of the intravenous urogram (IVU) is discussed. The service was designed to facilitate early diagnosis, particularly of bladder tumours, in new cases of haematuria. Potentially this would allow a more effective planning of operating lists and implementation of early definitive treatment. Within the setting of a District General Hospital, new cases of haematuria were studied (42 male, 29 female, mean age 60 +/- 13 years). Fifty-one had a pre-clinic IVU whereas 20 had this deferred until after their first visit. All patients underwent a flexible cystoscopy under local anaesthesia on their first visit. New cases of bladder cancer were placed on the next available list for definitive treatment whilst patients with normal cystoscopy were referred back to the clinic for further investigations. Altering the timing of the IVU helped in reducing hospital delay from 33 +/- 19 days (range 9-92 days) to 22 +/- 9 days (range 8-52 days; P < 0.04); the number of diagnostic cystoscopies performed within 4 weeks increased from 65% to 95%. The same day diagnostic service has not been difficult to administer. Patient acceptability was excellent and design objectives were achieved.