title: The need for repeated urological evaluation in low-risk patients with microscopic hematuria after negative diagnostic work-up.
abstract: OBJECTIVE
  To evaluate the role of repeated urological evaluation after negative initial diagnostic work-up of asymptomatic microhematuria (AMH) in low-risk patients.
  
  
  METHODS
  Criteria for patient inclusion were a complete negative initial diagnostic assessment including ultrasound (US), cystoscopy, upper urinary tract (UUT) imaging using intravenous urography (IVU) or multiphasic computed tomography (CT), absence of risk factors and a follow-up period of at least three years. Based on our institutional practice, urinalysis was repeated yearly; cystoscopy with US was repeated three years after initial work-up. The oncological outcome was evaluated across a mean follow-up of 8 (range: 3.7-10.2) years.
  
  
  RESULTS
  A case series of 87 (32.2% of 270) low-risk patients, 56 women and 31 men, with a mean age of 52.4 (range: 19-87) years was studied. Three years after initial work-up, cystoscopy confirmed no bladder carcinoma in any of these 87 patients. Prostate cancer was diagnosed in one (1.1%) patient. In five (5.6%) patients, nephrological evaluation due to concomitant proteinuria on follow-up demonstrated chronic renal insufficiency (n=3), IgA nephropathy (n=1) and papillary necrosis of the kidney (n=1).
  
  
  CONCLUSIONS
  Low-risk patients with persistent AMH after negative urological evaluation have a neglectable risk of developing bladder cancer on follow-up. Newly-discovered proteinuria on follow-up should be clarified by a nephrologist, as proteinuria could be a sign of significant glomerular disease.
authors: Associate Professor of Urology, Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. hannes.steiner@uki.at.
authors: Renate
authors: R
authors: Pichler
authors: Isabel
authors: I
authors: Heidegger
authors: Nicolai
authors: N
authors: Leonhartsberger
authors: Brigitte
authors: B
authors: Stöhr
authors: Friedrich
authors: F
authors: Aigner
authors: Jasmin
authors: J
authors: Bektic
authors: Wolfgang
authors: W
authors: Horninger
authors: Hannes
authors: H
authors: Steiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006417:Hematuria / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
keywords: Hematuria; bladder cancer; repeat evaluation; screening; second malignancy; urinary tract malignancy