Editorial Comment

Abstract

Asymptomatic microscopic hematuria (AMH) is a vexing problem for clinicians. Around 10%-15% of adults will have AMH during their lifetime and the American Urological Association Best Practice Policy recommends cystoscopy for all adults aged >40 years with microscopic hematuria and for those aged <40 years with risk factors for developing bladder cancer. 1 Grossfeld G.D. Litwin M.S. Wolf J.S. et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy—Part I: definition, detection, prevalence, and etiology. Urology. 2001; 57: 599-603 Abstract Full Text Full Text PDF PubMed Google Scholar , 2 Grossfeld G.D. Litwin M.S. Wolf Jr, J.S. et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy—Part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. 2001; 57: 604-610 Abstract Full Text Full Text PDF PubMed Google Scholar Despite these guidelines, many primary care physicians fail to refer patients with AMH for evaluation. 3 Nieder AM, Lotan Y, Nuss GR, et al. Are patients with hematuria appropriately referred to Urology? A multi-institutional questionnaire based survey. Urol Oncol, in press. Google Scholar One of the problems is the low risk of bladder cancer (2%-5%) and even lower risk of renal cancer, and the absence of tools to risk stratify patients based on likelihood for malignancy. The guidelines dictate the same evaluation strategy for all patients despite known differences in risk based on age, gender, ethnicity, smoking history, and environmental exposures. Utility of Urine Cytology in the Workup of Asymptomatic Microscopic Hematuria in Low-risk PatientsUrologyVol. 75Issue 6PreviewTo evaluate performance and cost-effectiveness of voided cytology in patients with pure asymptomatic microscopic hematuria (AMH). Although voided cytology has been validated for use in patients with a history of urothelial carcinoma (UC), its use in low-risk patients with AMH is controversial. Full-Text PDF ReplyUrologyVol. 75Issue 6PreviewThe commentary for our aforementioned article rightfully asserts the significant dilemma with which urologists are faced when evaluating low-risk patients with asymptomatic microscopic hematuria (AMH). Investigations used can have direct impacts on the sensitivity of cancer detection, as well as the overall cost of evaluation.1 Avoiding unnecessary investigation without affecting care is paramount. Although we support the use of AUA recommendations for AMH,2 which are designed to minimize under diagnosis, our series underscores the unproven nature of cytology in this specific population. Full-Text PDF