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Objectives: To review the literature to identify factors affecting haematuria assessment in bladder cancer., Methods: We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications indexed in EMBASE and Medline (PubMed) in March 2016 were searched, using the keywords 'hematuria', 'urinary bladder neoplasm(s)' and 'bladder tumor'. Studies evaluating the timeliness and adequacy of haematuria assessment in the context of bladder cancer were included. Exclusion criteria included age <18 years, animal studies and non-English articles., Results: Following our search strategy, a total of 17 articles were included in our study. All 17 studies commented on gender, with female gender associated with delayed and inadequate haematuria evaluation. Women waited longer than men for urological review (three studies) and bladder cancer diagnosis (three studies). Women were also less likely to be referred to urology (two studies), receive imaging (three studies) or have cystoscopy (two studies). In all, 10 studies commented on age, with the impression that advancing age is associated with a more thorough assessment. Smokers and those with microscopic haematuria appear to undergo a less thorough evaluation., Conclusion: Female gender is associated with sub-optimal haematuria evaluation, while older patients are evaluated more thoroughly. Smokers paradoxically undergo less comprehensive assessment. Further research on the impact of other factors is required., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

Objective: To identify factors that impact on the timeliness and adequacy of haematuria evaluation., Patients and Methods: We undertook a retrospective cohort study identifying patients who underwent cystoscopy for investigation of haematuria at our institution between 1 January 2015 and 31 December 2015. Data on patient demographics, smoking status, anticoagulation, type of haematuria and referring clinician were collected. Exclusion criteria included patient age <18 years, known history of bladder/urinary tract/renal cancer, cystoscopy for indications other than haematuria and unknown date of urology consultation. Primary outcome measures were: i) time from general practitioner (GP) referral to urology consultation, ii) time from urology consultation to cystoscopy, and iii) receipt of investigations in the 180 days prior to cystoscopy. Comparisons between risk factors were carried out using negative binomial regression for count outcomes and chi-square test for categorical outcomes., Results: Over the study period, 305 eligible cases (225 men, 80 women) were identified, of which 196 (64%) were referred by a GP. Patients waited a median of 38 days from GP referral to urology consultation and 28 days from urology consultation to cystoscopy. The median time to urology consultation was 65 days for women and 33.5 days for men (P = 0.020). However, the observed difference between men and women was no longer statistically significant on multivariable regression, with the only independent predictors of a shorter interval being visible haematuria and imaging suspicious for cancer. Anticoagulated patients were more likely to have imaging studies, in particular renal tract ultrasonography (P = 0.006), while only 61% of patients with visible haematuria received imaging. No significant differences in recent investigations between genders were observed., Conclusions: Gender is not a significant predictor of delayed haematuria assessment or receipt of recent investigations. Anticoagulated patients are more likely to receive imaging than patients without anticoagulation and patients with visible haematuria are not adequately imaged. Improved clinician and public education is required to ensure that all patients are evaluated appropriately., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

Background: Necrobiosis lipoidica diabeticorum (NLD) is a granulomatous skin reaction found in < 1% of diabetic patients. Our purpose was to determine if NLD represented areas of cutaneous ischemia., Methods: Using laser Doppler flowmetry, we measured cutaneous blood flow in nine diabetic patients at NLD lesions and at contiguous uninvolved sites. Flow values were also determined at several reference sites noncontiguous with the NLD lesions and compared to age- and sex-matched controls: 24 diabetic subjects without skin abnormalities, 18 diabetic patients with dermopathy, and 40 nondiabetic subjects., Results: NLD lesions exhibited significantly higher blood flow (4.8 +/- 0.7 ml/min/100 g) than areas of unaffected skin close to the lesions (1.2 +/- 0.1 ml/min/100 g) (P < 0.01 for both comparisons). There were no significant differences in flow between normal skin sites in NLD patients and normal sites in diabetic patients without skin lesions., Conclusions: Our findings refute the hypothesis that NLD is a manifestation of microvascular ischemic disease of the skin. The increased blood flow seen in NLD lesions suggests an ongoing inflammatory process.