Guideline of Guidelines - Asymptomatic Microscopic Haematuria

To review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH).

This is a review of the haematuria guidelines from 1.) American Urological Association (AUA), 2. ) consensus statement from the Canadian Urological Association, Canadian Urologic Oncology Group, and Bladder Cancer Canada, 3.) American College of Physicians (ACP), 4.) Joint Consensus Statement of the Renal Association (RA) and British Association of Urological Surgeons (BAUS), and 5.) National Institute for Clinical Excellence (NICE).

All guidelines reviewed recommend evaluation for AMH, in absence of potential benign aetiologies, with the work up including cystoscopy and upper urinary tract imaging. Existing guidelines vary in the definition of AMH (role of urine dipstick versus urine microscopy), age threshold for recommending evaluation, and the optimal imaging modality (computed tomography versus ultrasound). Of the reviewed guidelines, none recommend use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation.

Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, this entity represents a valuable future research opportunity. This article is protected by copyright. All rights reserved.

BJU international. 2017 Sep 16 [Epub ahead of print]

Brian J Linder, Edward J Bass, Hugh Mostafid, Stephen A Boorjian

Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom.