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Asymptomatic microscopic hematuria in women

Whiteside, James L.a; Yuen, Hoi T.H.b

Current Opinion in Obstetrics and Gynecology: December 2019 - Volume 31 - Issue 6 - p 471–476
doi: 10.1097/GCO.0000000000000573
UROGYNECOLOGY: Edited by Kavita Mishra

Purpose of review The purpose of this review is to summarize the problem of asymptomatic microscopic hematuria (AMH) in women and the most recent publications on the topic.

Recent findings Urologic malignancy is rarely associated with AMH in low-risk women. Screening for urologic malignancy includes upper urinary tract imaging and cystoscopy. Renal ultrasound is a cost-effective first-line imaging modality in patients with AMH. Multiphasic computed tomography (CT) urography increases healthcare costs, the risk of secondary malignancy due to cumulative radiation exposure, and the discovery of incidental benign findings resulting in additional work-up. Cystoscopy is universally recommended as a diagnostic test in the evaluation of AMH but it is not without harm. Reliable risk factors for urologic malignancy in women are age, smoking, and possibly the presence of visible blood in the urine. Given the infrequency of these cancers and the performance characteristics of diagnostic testing in this context there is a need for better diagnostic strategies incorporating these risk factors in estimating the woman's risk.

Summary There is a need for sex-specific guidelines to risk stratify diagnostic evaluation for urologic malignancy in women with AMH. The low prevalence of these malignancies in women render diagnostic testing (e.g., cystoscopy and multiphasic CT urography) less impactful and pose unwarranted risk and significant healthcare costs.

aUniversity of Cincinnati

bThe Christ Hospital, Cincinnati, Ohio, USA

Correspondence to James L. Whiteside, MD, MA, MHA, FACOG, FACS, Department of Obstetrics and Gynecology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0526, USA. Tel: +1 513 558 5722; fax: +1 513 475 7179; e-mail:

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