geoffrey modest medical blogs

the Am Urol Assn just released their 2020 recommendations for the diagnosis, evaluation and followup of microhematuria (see  hematuria guidelines AUA2020  in dropbox, or go to  http://auanet.org/guidelines/microhenaturia  ). Main points: --microhematuria is  defined as >3 RBCs/hpf (high-power microscope field), not by a positive dipstick: strong recommendation, Grade C evidence level --there should be the same evaluation fo r patients on antiplatelet or anticoagulant meds as others (history, PE, risk factors for renal dz, GU malignancy, gyn causes) : strong recommendation, Grade C  evidence level --if there is other etiology (gyn, gu sources, or UTI), repeat urinalysis for microhematuria to ensure resolution : strong recommendation, Grade C  evidence level --risk-based urologic evaluation should be performed (the 4414 patients studied for the Hematuria Risk Index found that the low risk group had  0.2% chance of malignancy, intermediate risk gr...

A theoretical analysis suggested that our current guidelines (via Am Urol Assn) to working up hematuria, vs guidelines in several other countries, may well lead to increased radiation-induced cancer (see  hematuria avoid CT jamaintmed2019 in dropbox, or doi:10.1001/jamainternmed.2019.2280) Details: -- current guidelines for working up hematuria:     -- American Urological Association (AUA): if >35 yo, cystoscopy plus CT urography     -- Dutch: if >50 yo, cystoscopy plus ultrasonography     -- Canadian Urological Association (CUA): if >40 yo, cystoscopy plus ultrasonography     -- Kaiser Permanente (KP): if patients had gross hematuria, cystoscopy along with CT urography; smokers, males, or anyone >50yo had cystoscopy plus ultrasonography; non-smoking females <50yo had no workup     -- Hematuria Risk Index (HRI): risk scores were calculated, and no workup if low-risk, c...