MP08-04 DIAGNOSTIC EVALUATION OF MICROSCOPIC HEMATURIA IN YOUNG ADULTS: TIME TO RETHINK THE AMERICAN UROLOGICAL ASSOCIATION GUIDELINE

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-04 DIAGNOSTIC EVALUATION OF MICROSCOPIC HEMATURIA IN YOUNG ADULTS: TIME TO RETHINK THE AMERICAN UROLOGICAL ASSOCIATION GUIDELINE Erfan Amini, Farhad Pishgar, Mohsen Ayati, Bita Foratikashani, Iman Ghazi, Elnaz Ayati, Mohammad Reza Nowroozi, Majid Ali Asgari, Ramin Pourghorban, Faeze Salahshour, and Hassan Jamshidian Erfan AminiErfan Amini More articles by this author , Farhad PishgarFarhad Pishgar More articles by this author , Mohsen AyatiMohsen Ayati More articles by this author , Bita ForatikashaniBita Foratikashani More articles by this author , Iman GhaziIman Ghazi More articles by this author , Elnaz AyatiElnaz Ayati More articles by this author , Mohammad Reza NowrooziMohammad Reza Nowroozi More articles by this author , Majid Ali AsgariMajid Ali Asgari More articles by this author , Ramin PourghorbanRamin Pourghorban More articles by this author , Faeze SalahshourFaeze Salahshour More articles by this author , and Hassan JamshidianHassan Jamshidian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Underlying disorders associated with Microscopic hematuria (MH) vary from benign conditions to more serious causes such as urinary tract malignancies. American urological association has issued an updated guideline on asymptomatic MH in 2012, addressing this heterogeneity and emphasizing on detection of urinary tract malignancies. The recommended protocol includes cystoscopy and multiphasic computerized tomography urography (CTU) in all patients older than 35 years. Low detection rate of malignancies in patients with MH, has questioned the necessity of performing full evaluations and exposing patients to the risks of radiation, allergic contrast reactions and contrast-induced nephropathy, as well as, imposing financial burdens to the health systems. We conducted this study to evaluate the efficacy of various urologic investigations in determining etiology of MH in young adults. METHODS In this multi-institutional study, we retrospectively analyzed the records of 408 patients younger than 50 years with unexplained MH who underwent cystourethroscopy between December 2008 and January 2016. Furthermore, results of upper urinary tract investigations, including CTU or intravenous urography (IVU) and ultrasonography, as well as urine cytology and cystoscopy were obtained and analyzed to assess the role of each modality in determining the etiology of MH in young adults. RESULTS During the study period, we identified 408 patients with MH, who underwent cystourethroscopy. Mean age of patients was 38.7±7.3, ranging from 22 to 50 years. Extensive urological evaluations revealed no pathology in 363 (89.0%) patients. However, 37 (9.0%) and 8 (2.0%) patients were diagnosed with benign and malignant pathologies, respectively. In the present study, neither urine cytology nor upper tract imaging with CTU/IVU changed the diagnosis made by ultrasonography alone. However, cystoscopy was necessary for diagnosis of low grade bladder tumor in one patient. In multivariate analysis, age and the number of RBC/HPF were significantly associated with urothelial malignancies. CONCLUSIONS Our results showed that the probability of malignant pathologies is low in young patients presenting with MH. Moreover extensive urologic workup including upper tract imaging with CTU/IVU and voided urine cytology add little, if any information to that obtained by ultrasonography. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e91 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Erfan Amini More articles by this author Farhad Pishgar More articles by this author Mohsen Ayati More articles by this author Bita Foratikashani More articles by this author Iman Ghazi More articles by this author Elnaz Ayati More articles by this author Mohammad Reza Nowroozi More articles by this author Majid Ali Asgari More articles by this author Ramin Pourghorban More articles by this author Faeze Salahshour More articles by this author Hassan Jamshidian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...