SUFU 2019: Do We Need Gender Specific Guidelines?: Incidence of Significant Findings of Microhematuria Workup in Women

Miami, FL ( Asymptomatic microscopic hematuria (AMH) has been defined as ≥3 RBC/HPF on red blood cells per high-power field (RBC/HPF) on urinalysis (UA) in the absence of an obvious benign cause (e.g., infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or recent urological procedures). Current American Urological Association (AUA) guidelines recommend workup with a cystoscopy on patients aged 35 years and older or who have risk factors of urinary tract malignancies (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures), along with a radiologic evaluation of the upper tracts.

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