Ward AdmiSsion of Haematuria: an Observational mUlticentre sTudy (WASHOUT) - investigating management and outcomes of emergency admissions for bladder cancer

In the UK around 25,000 patients are admitted every year with blood in the urine, with bladder cancer being the leading underlying cause. If the bleeding continues unchecked this can lead to low blood levels needing blood transfusion, painful retention of urine from blood clots and in the worst cases, death. This study aims to observe how patients are managed in hospital and assess important outcomes such as length of hospital stay, timing of operations and the frequency of readmissions. The project also will find out the overall outcomes of bladder cancer, such as time to surgery and deaths at 90 days. The data collected during the study will be used to provide evidence for UK best practice guidelines.

Background: Haematuria (blood in the urine) accounts for 15% of emergency urology admissions in the UK [1,2] and is a common presentation of bladder cancer. The median length of stay has increased over the last 5 years from 8.5 days to 10 days. Once discharged, 10% of patients are readmitted with the same presentation. Patients in this cohort have a 30-day mortality rate of 5% and one-year mortality of 23% (bladder cancer being the primary cause), suggesting this cohort of patients may have the highest mortality rate of all common urological presentations. There is currently no available data on how many of these bladder cancer patients experience delayed diagnosis.

Significance: Despite the significant prevalence and challenging clinical outcomes faced by bladder cancer patients presenting with haematuria, there exists a notable gap in our understanding of optimal inpatient management, national healthcare outcomes, and strategies to curtail unnecessary use of resources. The likely high variability in emergency management of these bladder cancer patients across the UK, highlights the need for clear, standardised guidelines to improve patient outcomes and reduce healthcare expenditures. Compounding this issue is the risk of underlying malignancies in patients presenting with visible haematuria, as revealed by the landmark "IDENTIFY" study conducted by the BURST research collaborative. This study, encompassing 11,059 patients, found that 32% had a bladder malignancy.

Patient benefit: These insights, emphasise the urgent need for clear, standardised protocols to improve patient outcomes in this predominantly elderly and frail population, aiming to enhance care and mitigate the impact of bladder cancer.This project has also been awarded the ABC UK Andrew Meadows Award - given each year to a grants project which the panel considers to be of particular merit.

Project leads:

Dr. Kevin Byrnes MB BCh BAO MCh PhD is the current co-chair of the British Urology Researchers in Surgical Training (BURST) Research Collaborative - a trainee-led collaborative which delivers large-scale multicentre observational studies. With a scientific background - a PhD in anatomical sciences & developmental biology, as well as experience of clinical epidemiological studies - Kevin has a master's in surgical sciences and had led several clinical and epidemiological studies. He is an honorary lecturer with University College London and a specialist registrar in the London Deanery.

Dr Nikita Bhatt MBBS, MCh, MMed, FRCS (Urol) is doing a Fellowship in Functional and Female Urology at Newcastle upon Tyne Hospital, United Kingdom. In addition, she has an interest in Robotic and Reconstructive Urology. She completed her Urology training (residency) in the East of England deanery in 2023, and has completed a Masters in Medical Education with the University of Dundee and a Masters in Surgery with the National University of Ireland, Galway.

 

This project has also been awarded the ABC UK Andrew Meadows Award - given each year to a grants project which the panel considers to be of particular merit.

 

 

 

 

 

 Read about the other 2024 IOPP grant-awarded projects.