Objective: One of the common clinical problems warranting urologic evaluation is asymptomatic microscopic hematuria (AMH). According to some studies, it has prevalence as high as 38% with a possibility of urologic disease or malignancy around 23%. The presence of AMH would be quite a dilemma to a urologist in terms of how aggressive urologic evaluation and follow up is recommended. The present study was to determine the incidence of significant urologic diseases among Filipino patients with AMH on initial evaluation and on follow-up. This study would also determine if there would be a significant difference in terms of incidence of urologic disease among patients less than 35 years old and more than 35 years old with AMH.
Methods: A total number of 95 patients (38 male, 57 female) were included in this study. All patients presented with AMH. They were grouped in terms of age, gender, and duration of follow-up. All patients underwent cystoscopy and a diagnostic imaging (ultrasound, CT urogram, or CT stonogram) on initial evaluation. Patients then were followed up. They were divided into two groups, those less than 2 years of follow-up and those more than 2 years of follow-up. Excluded from the study are those patients with gross hematuria, on indwelling catheter, with urinary tract infection, with previous malignancy, history of pelvic irradiation, and those who did not undergo cystoscopy, or any urologic imaging.
Results: Out of 95 patients with AMH who underwent urologic evaluation, the incidence of urologic disease was noted to be 12% (11 out of 95). There was no malignancy related cause of AMH discovered. Age and gender failed to show any significant difference in terms of developing urologic disease. Among patients with negative findings on initial urologic evaluation, no urologic disease was noted even on follow-up. Among those with positive findings on initial evaluation, no new urologic disease was discovered on follow-up.
Conclusion: AMH has a low incidence of urologic disease or any GUT malignancy. Age and gender alone are not sufficient risk factors warranting an invasive endoscopic procedure. They are recommended only to those patients with high risk of urologic disease and can be avoided in majority of the population. We would recommend a kidney, urinary bladder, and prostate (KUBP) ultrasound as the initial imaging of choice since the only findings noted on evaluation through imaging were just two cases of nephrolithiasis, one via CT stonogram and the other through a CT urogram, which can also be diagnosed with a regular KUBP ultrasound. This would be more cost-effective as well as beneficial in terms of the patient’s risk regarding radiation and contrast-related effects. Clinicians may decrease unnecessary repeated urologic evaluation and follow-ups on patients with AMH, as the results of the study failed to show any significant difference in developing urologic disease for patients with persistent AMH on initial assessment and even on follow-up.
Key Words: Urologic disease, microscopic hematuria, hematuria.
- Samson P, Waingankar N, Shah P, Friedman D, Kavoussi L, Han J. Predictors of genitourinary malignancy in patients with asymptomatic microscopic hematuria. Urol Oncol [Internet]. 2018;36(1):10.e1-10.e6. Available from: http://dx.doi.org/10.1016/j.urolonc.2017.09.011
- Pichler R, Heidegger I, Leonhartsberger N, Stöhr B, Aigner F, Bektic J, et al. The need for repeated urological evaluation in low-risk patients with microscopic hematuria after negative diagnostic work-up. Anticancer Res. 2013;33(12):5525–30.
- Sountoulides P, Mykoniatis I, Metaxa L. Non-visible asymptomatic haematuria: a review of the guidelines from the urologist’s perspective. Expert Rev Anticancer Ther [Internet]. 2017;17(3):203–16. Available from: http://dx.doi. org/10.1080/14737140.2017.1284589
- Nielsen M, Qaseem A, for the High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: Advice for high-value care from the American college of physicians. Ann Intern Med [Internet]. 2016;164(7):488. Available from: http:// dx.doi.org/10.7326/m15-1496
- Barocas DA, Boorjian SA, Alvarez RD, Downs TM, Gross CP, Hamilton BD, et al. Microhematuria: AUA/SUFU guideline. J Urol [Internet]. 2020;204(4):778–86. Available from: http://dx.doi.org/10.1097/JU.0000000000001297
- Grossfeld GD, Litwin MS, Wolf JS, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part I: definition, detection, prevalence, and etiology. Urology [Internet]. 2001;57(4):599– 603. Available from: http://dx.doi.org/10.1016/ s0090-4295(01)00919-0
- Madeb R, Golijanin D, Knopf J, Davis M, Feng C, Fender A, et al. Long-term outcome of patients with a negative work-up for asymptomatic microhematuria. Urology [Internet]. 2010;75(1):20–5. Available from: http://dx.doi. org/10.1016/j.urology.2009.06.107
- Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol [Internet]. 2012;188(6 Suppl):2473–81. Available from: http://dx.doi.org/10.1016/j.juro.2012.09.078
- Niemi MA, Cohen RA. Evaluation of microscopic hematuria: a critical review and proposed algorithm. Adv Chronic Kidney Dis [Internet]. 2015;22(4):289–96. Available from: http://dx.doi.org/10.1053/j.ackd.2015.04.006
- Ritchie CD, Bevan EA, Collier SJ. Importance of occult haematuria found at screening. BMJ [Internet]. 1986;292(6521):681–3. Available from: http://dx.doi. org/10.1136/bmj.292.6521.681
- Lisanti CJ, Toffoli TJ, Stringer MT, DeWitt RM, Schwope RB. CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed? AJR Am J Roentgenol [Internet]. 2014;203(3):615–9. Available from: http:// dx.doi.org/10.2214/AJR.13.11891
- Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G, et al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc [Internet]. 2013;88(2):129– 38. Available from: http://dx.doi.org/10.1016/j. mayocp.2012.10.004
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