A new diagnostic algorithm for the evaluation of microscopic hematuria

Objectives. To evaluate a new diagnostic algorithm for microscopic hematuri a in which intravenous urography (IVU) is performed as a secondary radiogra phic study when microhematuria has persisted for 3 months after the initial workup with renal ultrasound (US) and cystoscopy was negative. Methods. We evaluated 372 consecutive patients who presented with microhema turia and negative urine cultures and cytologic findings at our institution . All patients underwent renal US scanning and cystoscopy as their initial evaluation. All patients underwent re-evaluation 3 months after the initial workup. Patients with persistent microhematuria with no apparent etiology were then evaluated with IVU. Results. The initial evaluation was negative in 212 of 372 patients. Eighty -one of these patients had persistence of their microhematuria at the 3-mon th follow-up without a definitive diagnosis. Seventy-five of these patients underwent IVU. Abnormalities were found in 11 of the 75 patients. Six pati ents had renal stones, two had ureteral stones, two had ureteral tumors, an d one had a tumor of the renal pelvis. Forty of the 131 patients with resol ution of their microhematuria underwent IVU at their request. All those stu dies were normal. Conclusions. The combination of cystoscopy and renal US along with urinalys is, urine culture, and cytology is a good initial evaluation in patients wi th microhematuria. Those patients with persistent microhematuria after 3 mo nths without definite etiology of the bleeding may still benefit from IVU. UROLOGY 57: 889-894, 2001. (C) 2001, Elsevier Science Inc.