Cystoscopy After Negative CT Urography in Microscopic Hematuria
Cystoscopy is not universally required when CT urography shows no lesions. [1] Cystoscopy is recommended based on the patient’s microhematuria risk category, not on CT urography findings alone. [1]
Risk Stratification Determines Need for Cystoscopy
- Low-risk microscopic hematuria includes men younger than 40 years and women younger than 50 years with 3 to 10 RBC/HPF on a single urinalysis, with <10 pack-year smoking history, and no other urothelial cancer risk factors. [1]
- Intermediate-risk microscopic hematuria includes men 40 to 59 years, women 50 to 59 years, 11 to 25 RBC/HPF on a single urinalysis, 10 to 30 pack-year smoking history, or persistent microscopic hematuria after an initial low-risk determination. [1]
- High-risk microscopic hematuria includes age 60 years or older, >25 RBC/HPF on a single urinalysis, >30 pack-year smoking history, or a history of gross hematuria. [1]
Core Recommendation for Intermediate- and High-Risk Disease
Cystoscopy is recommended for intermediate-risk microscopic hematuria. [1] Cystoscopy is recommended for high-risk microscopic hematuria. [1] These recommendations apply even when CT urography does not identify an upper tract lesion. [1]
Low-Risk Alternative to Immediate Cystoscopy
For low-risk microscopic hematuria, repeating urinalysis at 6 months is recommended as an alternative to immediate imaging and cystoscopy. [1] Cystoscopy and renal ultrasonography are also considered reasonable options for low-risk disease. [1]
Common Clinical Nuance After a Negative Upper Tract Study
A negative CT urography does not eliminate the need for bladder evaluation when the patient is categorized as intermediate- or high-risk. [1]
Follow-Up After a Negative Complete Evaluation
After a negative microscopic hematuria evaluation, repeat urinalysis within 12 months should be considered. [1] Evaluation may be discontinued if no microscopic hematuria is found on repeat urinalysis. [1]
Targets of Therapy
The goal of evaluation is exclusion of urothelial malignancy based on risk-adapted assessment of both the bladder and upper urinary tracts. [1]