Ambulatory & Office UrologyPatterns of Hematuria Referral to Urologists: Does a Gender Disparity Exist?
Section snippets
Data Source
The data were obtained from a medium-size, university-affiliated, nonprofit, managed care organization in the Midwest. The plan provided a variety of healthcare products, including a commercial and university health maintenance organization, a commercial point-of-service plan, Medicaid, and Medicare+Choice. As approved by the institutional review board, the participants with newly diagnosed hematuria from 1998 to 2002 were identified using the International Classification of Diseases, 9th
Results
During the study period, 926 consecutive patients met the entry criteria, including 559 men and 367 women, enrolled for a median of 5.2 years (range 1-17) before their diagnosis. The median enrollment times were similar between men and women (P = .63). The mean age of the men and women was 49 ± 17 years and 46 ± 16 years, respectively. The cohort demographics are summarized in Table 1. Of the male and female participants, 47% and 28% were referred for urologic consultation, respectively. A
Comment
In most patients, urologic evaluation was deemed unnecessary for a primary diagnosis of hematuria, with only 39% of patients requiring referral. The factor having the greatest influence on referral was the multiplicity of hematuria-related office visits, an indicator of a significant benign or malignant genitourinary condition.3 Advancing age also influenced urologic referral, likely prompted by the awareness of a substantially increased risk of genitourinary malignancies in persons >50-60
Conclusions
The findings from the present study suggest that a gender inequity in access to specialty evaluation of hematuria might exist. Primary care physicians practicing in a managed care setting were less likely to refer women for urologic evaluation of new or first recurrent episodes of hematuria. This disparity was even present for participants >60 years of age, when bladder cancer and other urologic malignancies are more common. This could potentially contribute to a delayed diagnosis of
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This study was supported by the Robert and Elizabeth Teeter Bladder Cancer Fund.