More recently, the American Urogynecological Society (AUGS) and the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion recommending the avoidance of a hematuria workup in women who are less than 50 years old, have <25 RBC/HPF, and who have no prior smoking history.
Daniel Elliot Rabinowitz, MD, and his group at the Maimonides Medical Center applied AUGS/ACOG recommendations to a large cohort of AMH patients and assessed the diagnostic accuracy as compared to the AUA guidelines. A retrospective institutional review of female patients who underwent AMH evaluation from 2012-2015 was performed, and a total of 620 women with AMH with either partial or complete AMH workups were included.99.7% of patients had CT imaging that was negative for cancer, and 99.2% had CT imaging that was negative for all causes of AMH. 99.6% of patients had cystoscopies that were negative for cancer, and 91.6% had cystoscopies that were negative for all causes of AMH. In 91.5% of patients, no cause for AMH was identified. Based on AUGS/ACOG recommendations, 20.3% (126/620) of AMH workups would have been avoided.
Two malignancies (one low-grade papillary noninvasive upper tract urothelial carcinoma on CT and one low-grade Ta bladder urothelial carcinoma on cystoscopy) were found, both of whom would have undergone a hematuria workup based on AUGS/ACOG recommendations.
With regards to non-malignant findings, the AUGS/ACOG workup had a sensitivity of 84.1%, a specificity of 95.1%, a negative predictive value of 92.1%, a positive predictive value of 89.8%, and an accuracy of 91.35, compared to that based on AUA guidelines.
Dr. Rabinowitz concluded that application of the AUGS/ACOG recommendations to this group of patients would not have resulted in missed diagnoses of malignancies and that it appears urologists should consider the development of gender-specific guidelines.
Presented By: Daniel Elliot Rabinowitz, MD, Urologic Surgery Resident, Maimonides Medical Center, New York, New York
Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida