ACOG updates guidelines on investigating microscopic hematuria in females.

courtesy: wn.com

Microscopic hematuria detected during urine analysis without any symptoms is an important clinical indicator of malignancy. Over the years, the definitions of microscopic hematuria have changed, but the data was primarily based on studies done on male patients.

The American College of Obstetricians and Gynecologists(ACOG)  and the American Urogynecologic Society (AUS) has updated its guidelines for low risk women presenting with microscopic hematuria.

The committee opinion was published online on March 30, 2017 ahead of print in Journal of Obstetrics and Gynecology.

Sex specific guidelines for microscopic hematuria were not available till now, although the differential diagnosis of microscopic hematuria varies considerably according to the sex of the patient.

Risk of urinary tract malignancies are considerably less in females.

In women older than 60 years, gross hematuria with a history of smoking is a strong predictor of urologic malignancy.

In women younger than 50 years, not presenting with gross hematuria with no history of smoking and fewer than 25 red blood cells per high-power field on microscopic urine examination the risk of urinary tract malignancy is less than .5%.

Evaluation of such patients is not cost effective and may result in more harm than benefit. Hence, the data supports changing the guidelines in low risk groups.

ACOG and AUS has recommended the organization formulating guidelines to analyze sex specific data and formulate sex specific guidelines.

In the meantime, ACOG and AUS recommend that women between 35-50 years of age, who do not have any symptoms or a history of smoking should undergo evaluation only if they have more than 25 red blood cells per high-power field.