Microscopic Hematuria (2020 AUA Guidelines): Difference between revisions

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'''See [https://pubmed.ncbi.nlm.nih.gov/32698717/ Original Guidelines]'''

~~'''See AUA Asymptomatic Microscopic Hematuria Guidelines 2016'''~~

'''See [[CUA: Asymptomatic Microscopic Hematuria (2008)|CUA Asymptomatic Microscopic Hematuria Guidelines 2008]]'''

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*# '''Imaging: upper tract imaging (intermediate, high-risk, and if family history of RCC or other genetic renal tumor syndrome)'''

*#* '''US for intermediate-risk'''

*#** '''Optional for low-risk'''

*#* '''CT urography for high-risk'''

*# '''Cystoscopy (intermediate and high-risk)'''

*#* '''Optional for low-risk'''

**'''Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging should undergo repeat UA within 6 months'''

=== History and Physical Exam ===

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=== Low-risk ===

* The likelihood of upper tract malignancy is exceedingly low

* ~~Clinicians should discuss cystoscopy~~ and imaging with renal ultrasound ~~as options for evaluation, but should also review the option to repeat UA~~

* '''Options (2)'''

** Repeat UA should be performed within 6 months in order to limit the delay in diagnosis of curable malignancy should an underlying cancer be present.

** '''Cystoscopy and imaging with renal ultrasound'''

** '''Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging and who are found to have microhematuria on repeat urine testing should be reclassified as intermediate- or high-risk.'''

** '''Repeat UA (should be performed within 6 months in order to limit the delay in diagnosis of curable malignancy should an underlying cancer be present)'''

*** '''In such patients, clinicians should perform cystoscopy and upper tract imaging in accordance with recommendations for these risk strata.'''

* '''Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging and who are found to have microhematuria on repeat urine testing should be reclassified as intermediate- or high-risk.'''

*** In one large study, patients who had persistent MH on repeat urine testing had a higher rate of malignancy on subsequent evaluation as compared with those who had negative repeat urine testing

** '''In such patients, clinicians should perform cystoscopy and upper tract imaging in accordance with recommendations for these risk strata.'''

** In one large study, patients who had persistent MH on repeat urine testing had a higher rate of malignancy on subsequent evaluation as compared with those who had negative repeat urine testing

== Negative evaluation ==

@@ Line 1: / Line 1: @@
 '''See [https://pubmed.ncbi.nlm.nih.gov/32698717/ Original Guidelines]'''
-'''See AUA Asymptomatic Microscopic Hematuria Guidelines 2016'''
 '''See [[CUA: Asymptomatic Microscopic Hematuria (2008)|CUA Asymptomatic Microscopic Hematuria Guidelines 2008]]'''
@@ Line 107: / Line 105: @@
 *# '''<span style="color:#ff0000">Imaging: upper tract imaging (intermediate, high-risk, and if family history of RCC or other genetic renal tumor syndrome)</span>'''
 *#* '''<span style="color:#ff0000">US for intermediate-risk</span>'''
+*#** '''<span style="color:#ff0000">Optional for low-risk</span>'''
 *#* '''<span style="color:#ff0000">CT urography for high-risk</span>'''
 *# '''<span style="color:#ff0000">Cystoscopy (intermediate and high-risk)</span>'''
+*#* '''<span style="color:#ff0000">Optional for low-risk</span>'''
+**'''<span style="color:#ff0000">Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging should undergo repeat UA within 6 months'''
 === History and Physical Exam ===
@@ Line 198: / Line 199: @@
 === Low-risk ===
 * The likelihood of upper tract malignancy is exceedingly low
-* Clinicians should discuss cystoscopy and imaging with renal ultrasound as options for evaluation, but should also review the option to repeat UA
+* '''<span style="color:#ff0000">Options (2)'''
-** Repeat UA should be performed within 6 months in order to limit the delay in diagnosis of curable malignancy should an underlying cancer be present.
+** '''<span style="color:#ff0000">Cystoscopy and imaging with renal ultrasound'''
-** '''Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging and who are found to have microhematuria on repeat urine testing should be reclassified as intermediate- or high-risk.'''
+** '''<span style="color:#ff0000">Repeat UA (should be performed within 6 months in order to limit the delay in diagnosis of curable malignancy should an underlying cancer be present)'''
-*** '''In such patients, clinicians should perform cystoscopy and upper tract imaging in accordance with recommendations for these risk strata.'''
+* '''<span style="color:#ff0000">Low-risk patients who initially elected not to undergo cystoscopy or upper tract imaging and who are found to have microhematuria on repeat urine testing should be reclassified as intermediate- or high-risk.'''
-*** In one large study, patients who had persistent MH on repeat urine testing had a higher rate of malignancy on subsequent evaluation as compared with those who had negative repeat urine testing
+** '''In such patients, clinicians should perform cystoscopy and upper tract imaging in accordance with recommendations for these risk strata.'''
+** In one large study, patients who had persistent MH on repeat urine testing had a higher rate of malignancy on subsequent evaluation as compared with those who had negative repeat urine testing
 == Negative evaluation ==