Microscopic Hematuria: New AUA/SUFU Guidelines Published July 2020

Microscopic Hematuria: New AUA/SUFU Guidelines Published July 2020 Posted By:
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A new version of the American Urologic Association (AUA)/Society of Urodynamics & Female Urology (SUFA) guideline for microhematuria has just been published this summer. The updated guideline provides clinicians with a framework for the diagnosis, evaluation, follow-up, and treatment of microhematuria.

Hematuria is one of the most common urologic diagnoses and accounts for more than 20% of urologic evaluations. This guideline update, revised from the 2016 version, recommends risk stratification of patients with microhematuria into low risk, initially low risk with hematuria on repeat urinalysis, immediate risk, and high risk. Stratification of patients allows the provider to determine what aspects of the diagnostic evaluation are recommended based on the patient's risk factors: This is a new development from the previous guidelines. In addition to risk stratification, the updated guidelines highlight the importance of shared decision-making while explaining diagnosis and treatment options to patients.

Low-risk patients would be evaluated differently than high-risk, and shared decision-making plays a role in allowing the patient to understand recommendations in the timing of their repeat assessment, or the decision to move forward with more aggressive evaluation. Patients who initially present as low risk but have repeat findings of microhematuria should be counseled on the evidence that suggests an increased risk. Intermediate-risk patients have strong recommendations for evaluation, and high-risk patients have clear recommendations for the various diagnostic aspects of evaluation.

The 2020 guidelines also include a discussion of diagnostics, upper tract imaging in high-risk patients, the use of cystoscopy, cytology, and urinary markers. Guideline development was influenced by a systematic review of primary literature studies to form evidence-based recommendations; these recommendations involve patient follow-up and design of surveillance and treatment plans.

Advanced practice providers (APPs) are expected to use evidence-based practice and follow clinical guidelines and evidence-based methodology for the diagnosis and evaluation of patients with a variety of clinical symptoms. Guidelines for microhematuria can be utilized by both urologic providers and primary care providers. An APP may find the diagnosis and differentials along with a discussion of each guideline statement useful, as well as why a statement or recommendations received its evidence grade and evaluation by risk stratification. A review of this guideline may also help guide a primary care provider to make a urology referral for their patients.

The guideline statements, steps in evaluation, and risk stratification are clear and easy to follow. There is an excellent review of prevalence, etiology, and diagnostic evaluation. The guideline also provides a strength of evidence definition and a rating system to help the provider understand the body of evidence that would support a recommendation. It provides a good explanation of linking the guideline statements to the level of certainty and the body of evidence strength. The guideline is also associated with an algorithm which follows the text version of the guideline.

In our practice we use guidelines so patients will receive the best evidence-based care. Keeping the updated algorithm available and accessible ensures that each time we see a patient with a diagnosis of microhematuria, we are able to counsel them through shared decision-making with evidence-based recommendations.

References
  • American Urological Association. Microhematuria: AUA/SUFU guideline. www.auanet.org/guidelines/microhematuria. Accessed Sept 29, 2020.
  • Mariani AJ, et al. The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis. J Urol. 1989;141:350-355./li>

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Filed under: Urology , Oncology/Hematology

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