Time to abandon testing for microscopic haematuria in adults?

doi:10.1136/bmj.326.7393.813

BMJ 2003;326:813-815 ( 12 April )

Education and debate

Time to abandon testing for microscopic haematuria in adults?

Per-Uno Malmström, professor.

Department of Urology, University Hospital, SE-75 185 Uppsala, Sweden

per-uno.malmstrom@kirurgi.uu.se

The first 150 words of the full text of this article appear below.

Although there is no doubt that macroscopic haematuria is serious, the clinical significance of asymptomatic microscopic haematuriais controversial. Should it still be tested for?

Macroscopic haematuria has always been considered to be serious. Hippocrates stated, "If a patient passes blood, pus, andscales, in the urine, and if it has a heavy smell, ulcerationof the bladder is indicated." The clinical significance of "microhaematuria"(microscopic haematuria), on the other hand, is more controversial.No consensus exists on the role of asymptomatic microhaematuriain the diagnosis of diseases, and guidelines are contradictory.^1-3Thus, this finding, which has been brought to the fore by thewide use of dipstick testing, presents a dilemma for doctors andeven for patients.⁴ Recently the clinical importance of symptomaticmicrohaematuria has also been questioned.⁵ This article looksat the evidence base for the diagnostic value of microhaematuria.

Summary points

Microhaematuria is poorly predictive of cancers of the urinary tract
Haemoglobin dipstick testing is not a reliable way of detecting early bladder cancer in patients at high risk
Microhaematuria is not reliable evidence of a stone in the ureter and may be misleading, as it is often present in other serious conditions that cause acute loin pain
Testing for microhaematuria is not helpful in evaluating men with lower urinary tract symptoms

Methods

I was one of a panel of Swedish . . . [Full text of this article]

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This article has been cited by other articles:

Fernando, H., Thota, S. S, Burtt, G., Waterfall, N., Husain, I. (2007). Importance of red patches diagnosed in cystoscopy for haematuria and lower urinary tract symptoms. Postgrad. Med. J. 83: 62-63 [Abstract] [Full text]
Chow, K.M., Kwan, B.C., Li, P.K., Szeto, C.C. (2004). Asymptomatic isolated microscopic haematuria: long-term follow-up. QJM 97: 739-745 [Abstract] [Full text]

Rapid Responses:

Read all Rapid Responses

Testing for microscopic haematuria and the 2 week rule: Vibhash C Mishra, et al.
bmj.com, 11 Apr 2003 [Full text]
Evidence about disease probability should be sought, appraised, and used wisely: W Scott Richardson
bmj.com, 16 Apr 2003 [Full text]
Microscopic haematuria and a restricted outlook: Rowland L Cottingham
bmj.com, 16 Apr 2003 [Full text]
Microscopic hematuria: Important to differentiate true from false hematuria before further testing.: Malvinder S. Parmar
bmj.com, 22 Apr 2003 [Full text]
All patients with microhaematuria require investigation: JM Reynard
bmj.com, 23 Apr 2003 [Full text]
Re: Evidence about disease probability should be sought, appraised, and used wisely: PU Malmstr�m
bmj.com, 15 May 2003 [Full text]
Time to abandon traditional urinalysis?: Davide Giavarina
bmj.com, 22 May 2003 [Full text]