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How should we evaluate asymptomatic microscopic hematuria? A 2012 guideline from the American Urological Association (AUA) recommended that all patients older than 35 with microscopic hematuria — defined by the AUA as ≥3 red cells per high-power field — should undergo both computed tomography urography (CTU) and cystoscopy. But in 2020, an update of the guideline presents a more nuanced approach. It classifies patients into three categories of risk for genitourinary malignancy and recommends the following:
Low-risk patients: either repeating urinalysis at 6 months or proceeding with renal ultrasound and cystoscopy are acceptable.
Intermediate-risk patients: renal ultrasound and cystoscopy
High-risk patients: CTU plus cystoscopy
The guideline al…