Hematuria Meter Application as a Diagnostic Tool in the Assessment of the Degree of Hematuria Among Post-TURP and Post-TURBT Patients

Abstract

Introduction: Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of the Hematuria Meter Application, a mobile device software program.

Objective: The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counted per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.

Methods: Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine the agreement of the application readings with RBC/hpf and inter-observer agreement among the observers.

Results: From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT. The agreements of the Hematuria Meter Application readings with RBCs/hpf counted by Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post-operative day, ICC was 0.999 (p-value 0.000).

Conclusion: The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.