Safe to Skip Workup in Low-Risk Women With Asymptomatic Microhematuria

By Reuters Staff

July 23, 2020

NEW YORK (Reuters Health) - American Urologic Association (AUA) guidelines on evaluating asymptomatic microscopic hematuria (AMH) could lead to overscreening of low-risk female patients, new findings in Urology suggest.

"Extensive workup in a low risk group of female patients does not result in increased cancer diagnoses. Perhaps a more nuanced approach could result in fewer workups without compromising cancer detection," Dr. Daniel E. Rabinowitz of Maimonides Medical Center in Brooklyn, New York, and colleagues conclude.

The American Urogynecological Society (AUGS) and the American College of Obstetricians and Gynecologists (ACOG) have recommended against AMH workups for women aged 35-50 who have never smoked and have <25 red blood cells (RBC) per high-powered field (hpf) on urinalysis (UA), the authors note. But AUA guidelines advise that patients with >3 RBC/hpf on UA undergo cystoscopy and either cross-sectional multiphase upper urinary tract imaging or renal ultrasound, as well as intravenous or retrograde pyelograms to evaluate kidneys and ureters.

To compare the two guidelines, the authors reviewed data on 620 women evaluated for AMH at their center in 2012-2015, including 265 (42.7%) who had full workups as recommended by the AUA.

Overall, only 9% had more than 25 RBC/hpf. Higher RBC/hpf was not associated with increased risk of malignancy.

Malignancy was identified in two women (0.32%), both of whom had undergone workups as recommended by both sets of guidelines. Both patients were over 50 and had a history of tobacco exposure.

No cause was identified for AMH in 91.5% of the women.

Based on the AUGS/ACOG recommendations, 44 of the 265 women who underwent complete workups did not need them, while workups would not have been recommended for 126 women in the overall cohort, the authors note.

"In addition to being low-yield, workup carries risks of procedural discomfort, urinary tract infection (UTI), contrast-induced nephropathy (CIN), and high radiation exposure. These complications can generate high healthcare costs and impact quality of life," Dr. Rabinowitz and colleagues write. "Even without considering the possible complications, the workup can be costly for the patient and the healthcare system as a whole."

They conclude: "Future studies should attempt to risk stratify women presenting with AMH, and investigate potential unified guidelines from the AUA, AUGS and ACOG. This may result in fewer workups without compromising cancer detection."

Dr. Rabinowitz was not available for an interview by press time.

SOURCE: Urology, online July 8, 2020.