Should routine urinalysis be performed in an asymptomatic healthy adult male with no diabetes, hypertension, renal disease, urinary symptoms, or occupational screening requirements?

Routine Urinalysis in Healthy Asymptomatic Males: Not Recommended

Routine urinalysis should not be performed in an asymptomatic healthy adult male without diabetes, hypertension, renal disease, urinary symptoms, or occupational screening requirements. 1

Evidence Against Routine Screening

The U.S. Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to assess the balance of benefits and harms of routine screening for chronic kidney disease (which includes urinalysis) in asymptomatic adults without risk factors. 2 This "I statement" (insufficient evidence) applies specifically to patients like the one described—those without diabetes, hypertension, or known renal disease. 2

Poor Yield and High False-Positive Rate

• Abnormal urinalysis results occur in up to 34% of asymptomatic patients, yet lead to a change in clinical management in fewer than 14% of cases. 1
• Fewer than 1% of those management changes result in any meaningful clinical outcome. 1
• The diagnostic yield of routine screening is less than 3%, while false-positive results frequently trigger unnecessary follow-up investigations. 1

Potential Harms of Screening

• False-positive results lead to unnecessary diagnostic interventions including cystoscopy (with risks of bladder perforation, bleeding, and infection), CT urography (radiation exposure), and patient anxiety. 2
• Patients may be falsely labeled with chronic kidney disease and receive unnecessary treatment with resultant harmful effects from medications such as ACE inhibitors (cough, hyperkalemia), antihypertensives (hypotension), and calcium-channel blockers (edema). 2
• The psychological burden of labeling someone with disease when none exists is a documented harm. 2

When Urinalysis IS Indicated

Urinalysis should be obtained only when specific clinical indications are present:

Symptomatic Urinary Conditions

• Dysuria, urinary frequency, urgency, suprapubic pain, or other signs of urinary tract infection. 1
• Gross (visible) hematuria. 1
• New-onset or worsening urinary incontinence. 1
• Flank pain or costovertebral-angle tenderness. 1

Specific Medical Conditions Requiring Monitoring

• Diabetes mellitus (annual screening for albuminuria recommended by the American Diabetes Association). 2
• Hypertension being actively treated (recommended by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). 2
• Known chronic kidney disease requiring monitoring. 2

Pre-operative Evaluation (Limited Exceptions)

• Implantation of foreign material (prosthetic joint, heart valve). 1
• Invasive urologic procedures. 1
• Not indicated for routine elective surgery in asymptomatic patients. 1

Occupational Screening

• Workers with exposure to bladder carcinogens (benzenes, aromatic amines). 3

Risk Factors Do Not Justify Routine Screening

The USPSTF explicitly states that even in populations at increased risk for CKD—including older adults—routine screening is not recommended in the absence of diabetes or hypertension. 2 The National Kidney Foundation recommends assessing risk and testing only those at increased risk, not the general asymptomatic population. 2

Cost and Resource Considerations

• Ordering urinalysis solely because a patient is having a physical examination increases healthcare costs without improving outcomes. 1
• Widespread inappropriate urinalysis leads to a large number of evaluations for asymptomatic microhematuria, with associated cost and morbidity. 4
• In a 2018 analysis, 40% of urinalysis encounters did not have an appropriate diagnosis code, and only 27% had an appropriate primary diagnosis. 4

Common Pitfall to Avoid

Do not order "routine labs" including urinalysis as part of an annual physical examination in a healthy asymptomatic male without specific risk factors or symptoms. 1 Current guidelines do not support routine urinalysis screening in adults ≥60 years of age unless specific symptoms or procedural indications are present. 1