title: Microhematuria assessment an IBCN consensus-Based upon a critical review of current guidelines.
abstract: Assessment of patients with asymptomatic microhematuria (aMh) has been a challenge to urologists for decades. The aMh is a condition with a high prevalence in the general population and also an established diagnostic indicator of bladder cancer. Acknowledging aMh needs to be assessed within a complex context, multiple guidelines have been developed to identify individuals at high risk of being diagnosed with bladder cancer.
  
  
  
  This structured review and consensus of the International Bladder Cancer Network (IBCN) identified and examined 9 major guidelines. These recommendations are partly based on findings from a long-term study on the effects of home dipstick testing, but also on the assumption that early detection of malignancy might be beneficial.
  
  
  
  Despite similar designs, these guidelines differ in a variety of parameters including definition of aMh, rating of risks, use of imaging modalities, and the role of urine cytology. In addition, recommendations for further follow-up after negative initial assessment are controversial. In this review, different aspects for aMh assessment are analyzed based upon the evidence currently available.
  
  
  
  We question whether adherence to the complicated algorithms as recommended by most guidelines is practical for routine use. Based upon a consensus, the authors postulate a need for better tools. New concepts for risk assessment permitting improved risk stratification and prepone cystoscopy before refined imaging procedures (computed tomography scan and magnetic resonance imaging) are suggested.
authors.affiliation: Urologie 24/Urologie Schön Klinik Nürnberg Fürth, Europa-Allee 1, Fürth, Germany; Department of Urology, Friedrich-Alexander-Universität, Erlangen, Germany. Electronic address: bernd_sd@yahoo.de.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Schmitz-Dräger
authors.affiliation: Urologie 24/Urologie Schön Klinik Nürnberg Fürth, Europa-Allee 1, Fürth, Germany.
authors.forename: Eva C
authors.initials: EC
authors.lastname: Kuckuck
authors.affiliation: Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Tahlita C M
authors.initials: TC
authors.lastname: Zuiverloon
authors.affiliation: Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Zwarthoff
authors.affiliation: Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Saltzman
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Department of Urology, Diagnostic Clinic of Longview, Longview, TX.
authors.forename: M'Liss A
authors.initials: MA
authors.lastname: Hudson
authors.affiliation: Department of Urology, Inselspital, University of Berne, Berne, Switzerland; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Roland
authors.initials: R
authors.lastname: Seiler
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Department of Urology, Eberhard-Karl University, Tübingen, Germany.
authors.forename: Tilmann
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Division of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Vlahou
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.affiliation: Lucio Lascaray Research Center, University of the Basque Country, Vitoria-Gasteiz, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanchez-Carbayo
authors.affiliation: Urologische Klinik, St. Franziskus Hospital, Bielefeld, Germany.
authors.forename: Lenuta-A
authors.initials: LA
authors.lastname: Brünn
authors.affiliation: Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Bas W G
authors.initials: BW
authors.lastname: van Rhijn
authors.affiliation: Department of Urology, Friedrich-Alexander-Universität, Erlangen, Germany.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goebell
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.affiliation: Pitié Salpétrière Hospital, Assistance Publique- Hopitaux de Paris, University Paris 6, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Sharokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Lambertus A
authors.initials: LA
authors.lastname: Kiemeney
mesh_terms: D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000652:urine; D032921:Consensus; D003558:Cystoscopy; D006417:Hematuria / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology / Q000652:urine; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D063189:Symptom Assessment / Q000592:standards*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D014556:Urine / Q000166:cytology; D014567:Urography
chemical_list: D015415:Biomarkers
keywords: Bladder cancer; Diagnosis; Disease management; Guidelines; Microhematuria; Urine cytology; Urine markers