ACP issues high-value care advice on evaluating hematuria

The American College of Physicians issued high-value care advice this week on evaluating hematuria as a marker of occult urinary tract cancer.

Because hematuria is a common finding in ambulatory care, and patients often undergo routine urine dipstick testing and microscopic examinations despite absence of recommendations, ACP's High Value Care Task Force performed a narrative review of the available evidence to help inform clinical practice. The task force's goal was to describe indications for evaluation of hematuria as a marker of occult urinary tract cancer and offer advice to help clinicians make high-value decisions about referral for urologic assessment.

The Task Force's advice is as follows:

1. 1. Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria.
2. 2. Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.
3. 3. Clinicians should confirm hemepositive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.
4. 4. Clinicians should refer for further urologic evaluation all adults with gross hematuria, even if self-limited.
5. 5. Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.
6. 6. Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.
7. 7. Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.

The high-value care advice was published Jan. 26 by Annals of Internal Medicine. The full paper is available free of charge online.