#EAU15 - Diagnostic workup for asymptomatic microhematuria in patients younger than 50 years - Session Highlights

MADRID, SPAIN (UroToday.com) - The workup for asymptomatic microscopic hematuria frequently does not uncover a significant etiology. This is particularly true for younger patients in whom the risk for malignancy is decreased. Current AUA guidelines for microscopic hematuria recommends a cystoscopy be performed in all patients over 35-years old as well as a multiphasic contrast-enhanced CT, or MRI when CT is not feasible. In this study the authors looked to evaluate the efficacy of a complete hematuria work-up in patients younger than 50-years old.

eauThe authors included 275 consecutive patients younger than 50-years old who were evaluated for asymptomatic microscopic hematuria between December 2008 and March 2013. Patients with urolithiasis or a urinary tract infection were excluded from the study. All the study patients underwent a complete work-up including cystoscopy, cytology, and imaging. In total, 95% had no identifiable pathology, and in 3% the only abnormalities noted were simple renal cysts. Two renal masses (one AML and one RCC) and 4 bladder tumors were seen, all in patients between 35- and 50-years old. Ultrasound was adequate for detection of all but one bladder tumor seen on cystoscopy.

The authors concluded that the likelihood of malignant pathology is very low in patients younger than 50-years old with asymptomatic microhematuria. They stated that cystoscopy and cytology appear to add little, and suggested that ultrasound imaging may be adequate, particularly in patients under 35-years old. Further evaluation of assessment algorithms in younger patients are warranted to try to minimize tests which are likely to have little benefit and expose patients to unnecessary risks.

Presented by Amini E, Ayati M, Jamshidian H, and Nowroozi MR at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain

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Reported by Timothy Ito, MD, medical writer for UroToday.com