From the Guidelines
Repeat urinalysis for microscopic hematuria should be performed after resolution of the underlying gynecologic or non-malignant genitourinary cause, as recommended by the AUA/SUFU guideline 1. When to repeat urinalysis is dependent on the underlying cause of the microhematuria.
- In patients with gynecologic or non-malignant genitourinary sources of microhematuria, repeat urinalysis should be performed following resolution of the underlying cause.
- The AUA/SUFU guideline defines microhematuria as 3 red blood cells per high power field on microscopic evaluation of a single specimen 1.
- A risk classification system for patients with microhematuria has been created, stratified as low-, intermediate-, or high-risk for genitourinary malignancy, based on factors such as age, sex, smoking, and other urothelial cancer risk factors 1.
- Diagnostic evaluation with cystoscopy and upper tract imaging is recommended according to patient risk and involving shared decision-making 1.
- Statements also inform follow-up after a negative microhematuria evaluation, emphasizing the importance of monitoring and potential repeat testing in certain situations.
- The guideline emphasizes the importance of considering patient risk factors and the degree and persistence of microhematuria when determining the need for repeat urinalysis and further evaluation 1.
From the Research
Guidelines for Repeating Urinalysis for Microscopic Hematuria
- The decision to repeat urinalysis for microscopic hematuria should be based on the patient's risk factors and the results of the initial evaluation 2, 3.
- Patients with low-risk microscopic hematuria and a negative initial diagnostic work-up may not require repeated urological evaluation, as the risk of developing bladder cancer is negligible 3.
- However, patients with persistent microscopic hematuria should undergo repeated urinalysis and may require further evaluation, including renal function testing, urinary tract imaging, and cystoscopy 2, 4.
- The American Urological Association guidelines recommend that patients with asymptomatic microscopic hematuria undergo CT urography if they have more than 3 RBCs per high-power field in the absence of urinary tract infection 5.
- Repeated urinalysis may also be necessary to monitor for the development of proteinuria, which could be a sign of significant glomerular disease 3.
- The frequency of repeated urinalysis is not well established, but it may be reasonable to repeat urinalysis yearly in low-risk patients with microscopic hematuria 3.
- Patients with gross hematuria or those with risk factors for genitourinary cancer should undergo more frequent and thorough evaluation, including cystoscopy and imaging studies 2, 6.