A Visual Scale for Improving Communication When Describing Gross Hematuria

Published:December 04, 2020DOI:


      To create and validate a grading scale that facilitates communication between providers managing gross hematuria (GH).


      A blood simulant was used to create a spectrum of GH in 5 foley catheter tubes which were shown to a group of experienced urologists. The urologists were asked how they would adjust the continuous bladder irrigation rate if the samples represented the urine of hypothetical patients, and a 5-point scale was created by group consensus with pictures of the representative tubes printed onto a visual aid. Another cohort were then shown the 5 tubes at random and asked to describe the GH. Raters were then shown the visual aid and asked to assign a grade to the same samples. Fleiss’ kappa analysis was used to measure inter-rater agreement, and therefore fidelity of the scale.


      Fourteen urologists were surveyed to determine the samples used to create the 5-point scale. After the scale was created, 43 raters (22 nurses, 16 urologists, and 5 advanced practice providers) attempted match the tubes to their corresponding images on the printout. When asked to describe the degree of GH for the samples as they would in clinical practice, 28 different descriptors were used (mean 8.6 per sample). When using the 5-point GH scale, however, raters exhibited near perfect agreement in matching each sample to its corresponding severity on the scale (κ = 0.93, P < .001).


      We created a clinically useful GH scale that improves communication and reduces ambiguous language among providers of varying levels of experience.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stoffel JT
        • Moinzadeh A
        • Hansen M
        Identification of common themes from after-hour telephone calls made to urology residents.
        Urology. 2003;
        • Witherspoon L
        • Liddy C
        • Afkham A
        • Keely E
        • Mahoney J
        Improving access to urologists through an electronic consultation Service.
        Can Urol Assoc J. 2017;
        • Yafi FA
        • Aprikian AG
        • Tanguay S
        • Kassouf W
        Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system.
        J Can Urol Assoc. 2011;
        • Khadra MH
        • Pickard RS
        • Charlton M
        • Powell PH
        • Neal DE
        A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice.
        J Urol. 2000;
        • Hageman N
        • Aronsen T
        • Tiselius HG
        A simple device (Hemostick®) for the standardized description of macroscopic haematuria: our initial experience.
        Scand J Urol Nephrol. 2006;
        • Barocas DA
        • Boorjian SA
        • Alvarez RD
        • et al.
        Microhematuria: AUA/SUFU guideline.
        J Urol. 2020;
        • Landis JR
        • Koch GG
        A review of statistical methods in the analysis of data arising from observer reliability studies (Part I).
        Stat Neerl. 1975;
        • Coxon JP
        • Pattison SH
        • Parks JW
        • Stevenson PK
        • Kirby RS
        Reducing human error in urology: lessons from aviation.
        BJU Int. 2003;
        • Vermeir P
        • Vandijck D
        • Degroote S
        • et al.
        Communication in healthcare: a narrative review of the literature and practical recommendations.
        Int J Clin Pract. 2015;
        • Sakuma S
        • Fujita R
        • Komiya H
        A novel method for evaluating and expressing the degree of macroscopic hematuria.
        Int Urol Nephrol. 2006;
        • Wong LM
        • Chum JM
        • Maddy P
        • Chan STF
        • Travis D
        • Lawrentschuk N
        Creation and validation of a visual macroscopic hematuria scale for optimal communication and an objective hematuria index.
        J Urol. 2010;
        • Lee JY
        • Chang JS
        • Koo KC
        • Lee SW
        • Choi YD
        • Cho KS
        Hematuria grading scale: a new tool for gross hematuria.
        Urology. 2013;
        • Abdul-Muhsin H
        • Critchlow W
        • Navaratnam A
        • et al.
        Feasibility of holmium laser enucleation of the prostate as a 1-day surgery.
        World J Urol. 2020;
        • Olapade-Olaopa EG
        • Solomon LZ
        • Carter CJM
        • Ahiaku EKN
        • Chiverton SG
        Haematuria and clot retention after transurethral resection of the prostate: a pilot study.
        Br J Urol. 1998;
        • Palmisano F
        • Boeri L
        • Fontana M
        • et al.
        Incidence and predictors of readmission within 30 days of transurethral resection of the prostate: a single center European experience.
        Sci Rep. 2018;