Introduction

Underlying disorders associated with Microscopic hematuria (MH) vary from benign conditions to more serious causes such as urinary tract malignancies. American urological association has issued an updated guideline on asymptomatic MH in 2012, addressing this heterogeneity and emphasizing on detection of urinary tract malignancies. The recommended protocol includes cystoscopy and multiphasic computerized tomography urography (CTU) in all patients older than 35 years. Low detection rate of malignancies in patients with MH, has questioned the necessity of performing full evaluations and exposing patients to the risks of radiation, allergic contrast reactions and contrast-induced nephropathy, as well as, imposing financial burdens to the health systems. We conducted this study to evaluate the efficacy of various urologic investigations in determining etiology of MH in young adults.

Methods

In this multi-institutional study, we retrospectively analyzed the records of 408 patients younger than 50 years with unexplained MH who underwent cystourethroscopy between December 2008 and January 2016. Furthermore, results of upper urinary tract investigations, including CTU or intravenous urography (IVU) and ultrasonography, as well as urine cytology and cystoscopy were obtained and analyzed to assess the role of each modality in determining the etiology of MH in young adults.

Results

During the study period, we identified 408 patients with MH, who underwent cystourethroscopy. Mean age of patients was 38.7±7.3, ranging from 22 to 50 years. Extensive urological evaluations revealed no pathology in 363 (89.0%) patients. However, 37 (9.0%) and 8 (2.0%) patients were diagnosed with benign and malignant pathologies, respectively._x000D_ In the present study, neither urine cytology nor upper tract imaging with CTU/IVU changed the diagnosis made by ultrasonography alone. However, cystoscopy was necessary for diagnosis of low grade bladder tumor in one patient. In multivariate analysis, age and the number of RBC/HPF were significantly associated with urothelial malignancies.

Conclusions

Our results showed that the probability of malignant pathologies is low in young patients presenting with MH. Moreover extensive urologic workup including upper tract imaging with CTU/IVU and voided urine cytology add little, if any information to that obtained by ultrasonography.

Funding

None