Microhematuria: The Latest AUA/SUFU Guideline Recommendations
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. State the definition of microhematuria according to the AUA/SUFU guideline 2. Discuss the risk-stratification approach to the management of microhematuria
Estimated time to complete activity: 0.25 hours
Ashley Comfort, MD, FACOG is the Director of Medical Content, ObG Project.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Ashley Comfort, MD, has a financial interest in Pfizer and has no other conflicts of interest to disclose.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 3/31/2021 through 3/1/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.
Hematuria accounts for approximately 20% of all Urology referrals. It is typically characterized as either gross (visible blood in urine) or microhematuria (RBCs on UA). Hematuria can be linked to a variety of etiologies, including infection, calculi, BPH, and—most importantly—malignancy. Studies have shown vastly different rates of genitourinary (GU) malignancy in patients with hematuria (<1% to 10%). While patients with gross hematuria generally undergo cystoscopy to rule out cancer, the evaluation and management of microhematuria (MH) is more nuanced. The 2012 American Urological Association (AUA) guideline recommended cystoscopy and CT urogram for all patients >35 with MH. An updated 2020 AUA/ Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) guideline introduces a system of stratifying patients based on risk for GU malignancy to help guide diagnostic evaluation.
Definition of MH
≥3 RBCs/HPF on UA
Not diagnosed by urine dipstick
Work-up of MH
H&P to identify possible sources
e.g. UTI, medical renal disease, gynecologic, malignancy
Urine cytology not recommended as part of initial evaluation
Workup does not vary for patients on antiplatelets or anticoagulation
If gynecologic or non-malignant GU source identified, treat accordingly and repeat UA upon resolution
Refer to nephrologist if renal disease identified (e.g. cellular casts, proteinuria, elevated creatinine, or hypertension)
Categorize patient based on risk for GU malignancy to guide further workup
Low-risk: Must Meet All of the Following Criteria
Women < 50 | Men < 40
Smoking history: Non-smoker or <10 pack-years
UA: 3 to 10 RBCs/HPF and no prior MH
No additional risk factors for GU cancer, which include the following
Irritation with voiding | Cyclophosphamide/ifosfamide chemotherapy | Family history of GU cancer or Lynch Syndrome, industrial exposure to benzenes/aromatic amines(e.g., chronic indwelling foreign body in GU tract)
Intermediate-risk: Must meet ≥1 of the following criteria
Women 50 to 59 | Men 40 to 59
Smoking history: 10 to 30 pack-years
UA: 11 to 25 RBCs/HPF (or previously low-risk with no diagnostic workup and 3 to 25 RBCs/HPF)
≥1 additional risk factor for GU cancer (see above)
High-Risk: Must Meet ≥1 of the Following Criteria
Women and men ≥ 60
Smoking history: > 30 pack-years
UA: > 25 RBCs/HPF
History of gross hematuria
Low-risk: Choice of option based on shared decision-making
Repeat UA within 6 months or
Cystoscopy and renal ultrasound
Cystoscopy and renal ultrasound
Cystoscopy and CT urogram
Note: For all risk categories: If negative workup, “consider” repeat UA within 12 months
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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