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Microscopic Hematuria (2020 AUA Guidelines)
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==== 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'''
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