Moderated Poster

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MP08-04: Diagnostic evaluation of microscopic hematuria in young adults: Time to rethink the American Urological Association Guideline

Friday, May 12
9:30 AM - 11:30 AM
Location: BCEC: Room 160

Presentation Authors: Erfan Amini*, Farhad Pishgar, Mohsen Ayati, Bita Foratikashani, Iman Ghazi, Elnaz Ayati, Mohammad Reza Nowroozi, Majid Ali Asgari, Ramin Pourghorban, Faeze Salahshour, Hassan Jamshidian, Tehran, Islamic Republic of Iran

Introduction: Underlying disorders associated with Microscopic hematuria (MH) vary from benign conditions to more serious causes such as urinary tract malignancies. American urological association has issued an updated guideline on asymptomatic MH in 2012, addressing this heterogeneity and emphasizing on detection of urinary tract malignancies. The recommended protocol includes cystoscopy and multiphasic computerized tomography urography (CTU) in all patients older than 35 years. Low detection rate of malignancies in patients with MH, has questioned the necessity of performing full evaluations and exposing patients to the risks of radiation, allergic contrast reactions and contrast-induced nephropathy, as well as, imposing financial burdens to the health systems. We conducted this study to evaluate the efficacy of various urologic investigations in determining etiology of MH in young adults.

Methods: In this multi-institutional study, we retrospectively analyzed the records of 408 patients younger than 50 years with unexplained MH who underwent cystourethroscopy between December 2008 and January 2016. Furthermore, results of upper urinary tract investigations, including CTU or intravenous urography (IVU) and ultrasonography, as well as urine cytology and cystoscopy were obtained and analyzed to assess the role of each modality in determining the etiology of MH in young adults.

Results: During the study period, we identified 408 patients with MH, who underwent cystourethroscopy. Mean age of patients was 38.7±7.3, ranging from 22 to 50 years. Extensive urological evaluations revealed no pathology in 363 (89.0%) patients. However, 37 (9.0%) and 8 (2.0%) patients were diagnosed with benign and malignant pathologies, respectively.
In the present study, neither urine cytology nor upper tract imaging with CTU/IVU changed the diagnosis made by ultrasonography alone. However, cystoscopy was necessary for diagnosis of low grade bladder tumor in one patient. In multivariate analysis, age and the number of RBC/HPF were significantly associated with urothelial malignancies.

Conclusions: Our results showed that the probability of malignant pathologies is low in young patients presenting with MH. Moreover extensive urologic workup including upper tract imaging with CTU/IVU and voided urine cytology add little, if any information to that obtained by ultrasonography.

Source Of Funding: None

Erfan Amini, 114101

Urology Department, Tehran University of Medical Sciences

Dr. Erfan Amini, MD, is Assistant Professor at department of urology, Tehran University of Medical Sciences, since 2014. He is also deputy of research at Uro-Oncology Research Center and representative of international affairs at department of Urology, Tehran University of Medical Sciences. Dr. Amini received his medical degree at Tehran University of Medical Sciences in 2007. He completed his urology residency at Modarres Hospital, Shahid Beheshti University of Medical Sciences in 2012.
In 2017, he was a urologic oncology research scholar at university of Southern California. His clinical and research interests center on urologic oncology and molecular urology.
Dr. Amini is a member of national elite foundation and gold medalist of chemistry Olympiad. He has also served as a member of national urologic oncology committee to design national urology cancer guidelines. He is reviewer of many international prestigious journals and has awarded several prestigious national prizes as an outstanding researcher.


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MP08-04: Diagnostic evaluation of microscopic hematuria in young adults: Time to rethink the American Urological Association Guideline

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