title: Microhematuria in Postmenopausal Women: Adherence to Guidelines in a Tertiary Care Setting.
abstract: OBJECTIVE
  In 2012 the AUA (American Urological Association) released a revision of the asymptomatic microscopic hematuria guidelines. Our study objectives were to assess adherence to these guidelines and describe the prevalence of urinary tract malignancy in postmenopausal women at our institution.
  
  
  METHODS
  This is a cross-sectional analysis of women older than 55 years evaluated at the Division of Urogynecology or Urology from August 2012 to August 2014 for a diagnosis of asymptomatic microscopic hematuria. Women who underwent evaluation for 3 or more red blood cells per high power field on microscopic urinalysis were considered to have true asymptomatic microscopic hematuria. Those evaluated after a dipstick test with blood who had fewer than 3 red blood cells per high power field on urinalysis or no urinalysis were considered positive dipstick. Demographics, laboratory values, imaging results and cystoscopy findings were extracted from electronic medical records.
  
  
  RESULTS
  Our study population included 237 women with a mean ± SD age of 67.1 ± 8.3 years. In our overall population 169 of 237 women (71.3%) had true asymptomatic microscopic hematuria, 48 (20.3%) had a positive dipstick test and 20 (8.4%) underwent evaluation in the setting of urinary tract infection. We detected 3 urinary tract malignancies (1.4%). One kidney cancer was identified in a 56-year-old current smoker with a urine dipstick result of 1+ blood. Bladder cancer was detected in a 58-year old smoker with 6 red blood cells per high power field on urinalysis and in a 64-year-old nonsmoker with 42 red blood cells per high power field on urinalysis.
  
  
  CONCLUSIONS
  In postmenopausal women evaluated for asymptomatic microscopic hematuria the overall prevalence of urinary tract malignancy was low at 1.4%. Of our population 28.7% underwent evaluation without meeting guideline criteria for asymptomatic microscopic hematuria. This demonstrates an opportunity to improve adherence to existing guidelines to provide high quality care and avoid unnecessary expensive testing.
authors.affiliation: Divisions of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina. Electronic address: Megan.bradley@duke.edu.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Bradley
authors.affiliation: University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Marcella G
authors.initials: MG
authors.lastname: Willis-Gray
authors.affiliation: Divisions of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.affiliation: Divisions of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nazema Y
authors.initials: NY
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D017698:Postmenopause; D015995:Prevalence; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014571:Urologic Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control / Q000652:urine
keywords: hematuria; morphological and microscopic findings; postmenopause; practice guideline; urinary tract