Long-term Outcome of Patients With a Negative Work-up for Asymptomatic Microhematuria

Ralph Madeb, Dragan Golijanin, Joy Knopf, Matthew Davis, Changyong Feng, Anne Fender, Laura Stephenson, Edward M. Messing*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Objectives: To assess the validity of the American Urological Association guidelines, we investigated 14-year outcomes of men aged ≥50 years who had hematuria detected in a bladder cancer (BC) screening trial, were thoroughly evaluated, and were not found to have urological cancers. The American Urological Association guidelines for follow-up of adults with asymptomatic microhematuria (MH) who have negative evaluations include repeat urinary cytologies, urinalyses, and office visits for several years, primarily to detect BC (Cohen and Brown, N Engl J Med 348: 2330-2338, 2003; and Grossfeld et al, Urology 57:604-610, 2001). Methods: Of 1575 screening participants, 258 had MH detected by daily home testing with the Ames hemastix during two 14-day periods. This test has been shown to accurately reflect MH on microscopic urinalysis when each is correctly performed. Any man with at least 1 positive test (≥"trace") underwent a complete evaluation including microscopic urinalysis, culture, cytology, complete blood count, serum creatinine, coagulation profile, intravenous urography or computed tomography scan, and cystoscopy. BC or other urological tumors was not detected in 234 participants. Using Wisconsin state tumor registry and death certificate data, the outcomes of these men were tracked for 14 years since their last testing. Results: Two of the 234 men (0.85%) developed BC during the 14-year follow-up, at 6.7 and 11.4 years after their negative evaluations; one died of BC 7.6 years after his last screening. During this follow-up, 0.93% of the screenees who tested negatively for hematuria had BC diagnosed, none within a year of their last testing date. Conclusions: Patients who have negative complete evaluations for asymptomatic MH have little chance of subsequently developing BC. The recommended "appropriate" follow-up for these patients may require reconsideration in light of these data.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
Issue number1
StatePublished - Jan 2010
Externally publishedYes

ASJC Scopus subject areas

  • Urology


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