Choosing Wisely:

Don’t routinely perform cystoscopy or imaging in asymptomatic, never-smoking women younger than 50 years with microscopic hematuria who have less than 25 RBC per high power field.

Rationale and Comments: Asymptomatic hematuria in women is common but less likely to be associated with a urinary tract malignancy compared with men. Data support changing the evaluation requirements for microscopic hematuria in this low-risk group of women. Organizations that do not risk-stratify based on gender may continue to recommend more aggressive diagnostic evaluation in low-risk women.
Sponsoring Organizations:
  • American Urogynecologic Society
  • Sources:
  • Systematic review
  • Disciplines:
  • Urologic
  • References: • Committee on Gynecologic Practice, American Urogynecologic Society. Committee opinion no. 703: asymptomatic microscopic hematuria in women. Obstet Gynecol. 2017;129(6):1153-1154.
    • Jeppson PC, Jakus-Waldman S, Yazdany T, et al. American Urogynecologic Society Systematic Review: Microscopic Hematuria as a Screening Tool for Urologic Malignancies in Women [published online ahead of print, 2019 Apr 12]. Female Pelvic Med Reconstr Surg. 2019;10.1097/SPV.0000000000000726.
    • Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl):2473-2481. (reviewed and reaffirmed in 2016)
    • Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK. Evaluation of microscopic hematuria and risk of urologic cancer in female patients. Am J Obstet Gynecol. 2017;216:146.e1-146.e7.
    • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7-30.

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