Editing Microscopic Hematuria (2020 AUA Guidelines) (section)

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">Signs and Symptom'''
**'''Degree of hematuria'''
** '''Persistence of hematuria'''
** '''History of gross hematuria'''
** '''Irritative lower urinary tract symptoms'''
*'''<span style="color:#ff0000">Risk factors for malignancy (8):'''
*# '''<span style="color:#ff0000">Age'''
*# '''<span style="color:#ff0000">Male sex'''
*# '''<span style="color:#ff0000">Smoking'''
*# '''<span style="color:#ff0000">Prior pelvic radiation therapy'''
*# '''<span style="color:#ff0000">Prior cyclophosphamide/ifosfamide chemotherapy'''
*# '''<span style="color:#ff0000">Family history of urothelial cancer or Lynch Syndrome'''
*# '''<span style="color:#ff0000">Occupational exposures to benzene chemicals or aromatic amines (e.g., rubber, petrochemicals, dyes)'''
*# '''<span style="color:#ff0000">Chronic indwelling foreign body in the urinary tract'''
* '''<span style="color:#ff0000">Other causes of microscopic hematuria'''
**'''<span style="color:#ff0000">Medical renal disease'''
*** '''Proteinuria, dysmorphic RBCs, cellular casts, or renal insufficiency on urine microscopy may be associated with medical renal disease, which can cause hematuria'''
**** '''If medical renal disease is suspected, refer patients for nephrologic evaluation. However, risk-based urologic evaluation should still be performed.'''
** '''<span style="color:#ff0000">Gynecologic and non-malignant genitourinary causes of MH'''
*** '''Repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause.'''
**** '''<span style="color:#ff0000">Microscopic hematuria may not resolve for several weeks to a few months following treatment of a gynecologic or non-malignant cause of MH, or treatment of a UTI; waiting ≥ 3 weeks after resolution of the non-malignant etiology and ≤ 3 months would be appropriate.'''
***** '''If MH persists or the etiology cannot be identified, perform risk-based urologic evaluation.'''
**** '''Causes of MH that persist and may not require intervention (3):'''
****# Enlarged prostates and friable surface vessels
****# Randall’s plaques and non-obstructing stones
****# Women with pelvic organ prolapse or vaginal atrophy
***** In these cases, use careful judgment and shared decision-making to decide whether to pursue MH evaluation. Attention to the patient’s risk factors for urologic malignancy should inform these decisions.
** '''MH in patients who are taking anti-coagulants requires the same evaluation evaluation regardless of the type or level of anti-coagulation therapy'''

==== Physical Examination ====
* '''<span style="color:#ff0000">General'''
**'''<span style="color:#ff0000">Blood pressure measurement'''
* '''<span style="color:#ff0000">Genitourinary examination'''
**In females, examination of the external genitalia, introitus, and periurethral tissue may identify urethral pathology or other gynecologic pathology to explain the MH.