Microscopic Hematuria in Adults: Updated Recommendations from the American Urological Association

A single urinalysis is sufficient because 95% of microscopic hematuria is detected in one sample. Because at least 20% of positive dipstick tests for blood have no red blood cells on subsequent urine microscopy, any positive dipstick should be confirmed. Less common risk factors for urinary tract cancer include a family history of cancer or cancer-related syndromes, occupational exposure to benzene or aromatic amines, previous pelvic radiation therapy, previous cyclophosphamide chemotherapy, or chronic indwelling catheter or foreign body. The recommendation to repeat urinalysis after six months in patients at low risk and within a year after a negative workup might be controversial in primary care. Because the future laboratory evaluations are often missed by patients, the shaky evidence behind this recommendation is concerning.