Time to abandon testing for microscopic haematuria in adults?

doi:10.1136/bmj.326.7393.813

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Per-Uno Malmström, professor (per-uno.malmstrom@kirurgi.uu.se)

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

Accepted 21 January 2003

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

Macroscopic haematuria has always been considered to be serious. Hippocrates stated, “If a patient passes blood, pus, and scales, in the urine, and if it has a heavy smell, ulceration of 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 microhaematuria in the diagnosis of diseases, and guidelines are contradictory.1^–3 Thus, this finding, which has been brought to the fore by the wide use of dipstick testing, presents a dilemma for doctors and even for patients.4 Recently the clinical importance of symptomatic microhaematuria has also been questioned.5 This article looks at 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 general practitioners and urologists set up by National Board of Health and Welfare in Sweden 1999 to formulate evidence based policy statements and recommendations for evaluating microhaematuria in adults. The panel recommended that testing for microhaematuria should be abandoned. This article continues that work and is based on an updated computer aided literature search up to May 2002 aimed at addressing four key questions: