Table 2.

Clinical studies evaluating applications of telehealth in the diagnosis of hematuria.

Reference	Study design	Cases	Studied intervention	Methods	Endpoint	Results
Safir (2016) [31]	Prospective series	150	Teleurology clinic for patients referred for hematuria utilizing a telephone call to obtain hematuria- related clinical information.	Patients with hematuria were scheduled for a dedicated telephone appointment consisting of a structured interview performed by a physician resident. Each teleurology appointment consisted of an approximately 20–25-min encounter, during which the provider used a structured interview to obtain routine hematuria-related clinical information and completed a template-based hematuria consult note in the electronic medical record. At the end of the telephone encounter, the provider arranged for the patient to undergo upper tract imaging, flexible cystoscopy, and additional studies, if indicated. Patients were provided cystoscopy appointments within 30 d. A physical examination was performed on the day of cystoscopy	Efficacy and satisfaction with telephone appointments or hematuria consults. Patients were offered a voluntary, anonymous survey to evaluate their telephone clinic experience following cystoscopy. A 29-question survey regarding overall acceptance and satisfaction of the clinic (8 questions) and impact factors (21 questions)	Median time from consultation request to appointment was 12 d and thereafter to cystoscopy was 16 d. Patients reported high acceptance and overall satisfaction with telephone evaluation; mean scores exceeded 9 out of 10 for overall satisfaction, efficiency, convenience, friendliness, care quality, understandability, privacy, and professionalism. When presented with a choice, nearly all patients (98%) preferred telephone-based encounters to face-to-face clinic visits due to transportation-related issues (97%) and logistical clinic issues (65%). Of patients, 97% reported high-quality evaluation
Sener (2018) [40]	Prospective series	212	Patients assessment in the clinic	Group A: 2 urologists seeing the patients in the clinic and taking a medical history and performing a physical examination	To evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria. The two groups separately ranked hematuria (0—no hematuria, 1—hematuria that does not require invasive treatment, 2—hematuria requiring bladder drainage or any form of active treatments)	Group A urologists were in accordance with 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203), and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among “blind” urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and nonserious hematuria, the rate of misdiagnosing serious cases is approximately 6.5–7%. However, using WhatsApp, the urologists can differentiate between normal urine and any form of hematuria with 100% accuracy
			Assessment of 2 pictures of voided urine in a sterile container via WhatsApp	Group B: 2 “blind” urologists who had no access to patients’ medical history, nor could they visit or see patients, but were permitted only to receive pictures via WhatsApp. Each patient was asked to urinate into a sterile container and take two pictures of the sample with their smartphone. The images were sent using WhatsApp via 3G technology
Zholudev (2018) [43]	Prospective series	300	Teleurology clinics	Cost comparison of teleurology versus face to face clinic regarding hematuria patients. Overall cost consisted of 3 cost categories: transportation, clinic operation (administrative, nursing, and provider related), and patient time	To understand the economic impact of teleurology in the initial evaluation of hematuria based on analysis and comparison of the cost of telephone encounters and conventional outpatient clinic encounters	Average patient time was greater for face-to-face encounters (266 vs 70 min, p < 0.001). Transportation was the primary driver of overall costs ($83.47 per encounter), followed by patient time ($32.87 per encounter) and clinic staff cost ($18.68 per encounter). The average cost per encounter was $135.02 for face-to-face clinic visit vs $10.95 for teleurology (p < 0.001), exclusive of provider and laboratory times. Cost savings associated with each tele-encounter totaled $124.07
		100	Standard clinics