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Microscopic Hematuria (2020 AUA Guidelines): Difference between revisions

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*# '''<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">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">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">CT urography for high-risk</span>'''
*# '''<span style="color:#ff0000">Cystoscopy (intermediate and 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 ===
=== History and Physical Exam ===
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=== Low-risk ===
=== Low-risk ===
* The likelihood of upper tract malignancy is exceedingly low
* The likelihood of upper tract malignancy is exceedingly low
* '''Options (2)'''
* '''<span style="color:#ff0000">Options (2)'''
** '''Cystoscopy and imaging with renal ultrasound'''
** '''<span style="color:#ff0000">Cystoscopy and imaging with renal ultrasound'''
** '''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">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)'''
* '''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">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 such patients, clinicians should perform cystoscopy and upper tract imaging in accordance with recommendations for these risk strata.'''
** '''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
** 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
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