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.
Low-risk: Must Meet All of the Following Criteria
Intermediate-risk: Must meet ≥1 of the following criteria
High-Risk: Must Meet ≥1 of the Following Criteria
Note: For all risk categories: If negative workup, “consider” repeat UA within 12 months
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Microhematuria: AUA/SUFU Guideline
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