Evaluation of the 2020 American Urological Association Microscopic Hematuria
Guidelines in Clinical Practice: Retrospective Chart Review Analysis
#MMPMID41343761
Munroe D
; O'Keefe J
; Wang D
; Moore MA
JMIR Form Res
2025[Dec]; 9
(?): e75929
PMID41343761
show ga
BACKGROUND: Hematuria is one of the most common urologic diseases seen within
clinical practice, with a prevalence range of 1.7%-31.1%. In 2020, American
Urological Association (AUA) guidelines were revised and recommend that following
initial evaluation, clinicians should categorize patients into three tiers (low
risk, intermediate risk, and high risk) based on various factors. Recent
literature has shown that the AUA guidelines have high clinical utility when
compared to other international guidelines such as those outlined by the
Hematuria Risk Index, Canadian Urological Association, and Kaiser Permanente;
however, this guideline remains unvalidated among the population of "well adults"
within the United States. OBJECTIVE: We used a retrospective study design to
evaluate data abstracted from the electronic medical records of patients seen in
the Emory Healthcare Executive Health Clinic from September 29, 2017, to January
29, 2021, to investigate the utility of risk stratification as a tool for
clinical decision-making. METHODS: According to the AUA risk stratification
system, patients were stratified into low-risk and intermediate-risk/high-risk
groups based on sex, age, smoking history, history of gross hematuria, and red
blood cells/high-powered field. The frequencies and percentages of different
causes of hematuria across the three risk strata were reported. RESULTS: Of the
882 instances of red blood cells in urine (URBC) ?3, a total of 368 (41.72%)
underwent a repeat analysis within a 6-month time span, 184 (20.86%) within a
12-month time span, and 330 (37.41%) at >12 months. Instances of a URBC <3
(N=1643) were more likely to have no urologic diagnosis-1503 (91.48%) in
comparison to 633 (76.27%) for those instances with a URBC >3 (N=830).
Ultimately, 23 (100%) participants in the low-risk group had no urologic
diagnosis after urinalysis versus 608 (75.62%) in the intermediate-risk/high-risk
group (N=804). CONCLUSIONS: We found a need for a greater focus on monitoring
elevated URBC counts, in accordance with clinical guidelines for managing
hematuria in low-risk patients. Future research should examine the impact of risk
stratification on clinical decisions and access to care, especially in
underserved populations. It should also assess how the new AUA guidelines affect
physician referral patterns and explore real-world implementation challenges and
facilitators.
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