What is the significance of hematuria in detecting patients with bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Urinalysis is used routinely to evaluate for the presence of red blood cells (RBCs), WBCs, and protein and to assess for urinary tract infection. The presence of RBCs in the urine mandates an evaluation by a urologist to investigate for any serious disease. American Urological Association (AUA) guidelines recommend against relying on dipstick testing alone to diagnose microhematuria, and instead advise following up a positive dipstick test with a formal evaluation; the AUA defines microhematuria as “≥3 red blood cells per high-power field on microscopic evaluation of a single properly collected urine specimen." Workup of microhematuria should be based on history and physical exam findings while taking into consideration the patient's individual risk factors for genitourinary malignancy. [65]

Gross hematuria always requires a careful assessment with imaging studies of the entire urinary tract (CT urography) and cystoscopy. However, prior to performing an endoscopic examination or initiating any therapy, a urine culture should be performed to confirm that the urine is free of evidence of infection. Although microhematuria may be present in healthy persons, 13-34.5% of patients with gross hematuria and 0.5-10.5% of patients with microscopic hematuria will be diagnosed with bladder cancer on initial evaluation. [65]

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