{"title":"Confirmatory Microscopic Urinalysis After Positive Dipstick Microhematuria: Adherence Patterns and Quality Improvement.","authors":"Taylor L Lan, Blake R Baer, Jay D Raman","doi":"10.1016/j.urology.2025.09.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate adherence to the 2025 AUA/SUFU microhematuria (MH) guideline, which requires confirmatory microscopic urinalysis (MUA ≥3 RBC/HPF) after a positive dipstick.</p><p><strong>Materials and methods: </strong>TriNetX Research Network data (109 US health systems) were queried for adults aged 18-90 years with an initial positive dipstick from July 2020 to February 2025. Patients with gross hematuria, urinary tract infections, and kidney and/or ureteral calculi, cystitis, proteinuria, dysuria, and pregnancy diagnoses were excluded. Patients were stratified into three cohorts: no MUA, negative MUA, and positive MUA. We recorded the use of computed tomography (CT) urography, magnetic resonance imaging (MRI) urography, renal ultrasound, or cystoscopy within 6 months of positive dipstick.</p><p><strong>Results: </strong>Among 37,300 eligible patients, 25,904 (69%) received MUA and 11,396 (31%) did not. MUA was positive in 9913 cases (38%) and negative in 15,991 (62%). Downstream testing followed 7.5% of dipstick-only cases, 16.1% of negative-MUA cases, and 16.3% of positive-MUA cases. In total, 855 procedures were performed without any MUA and 2575 after a negative MUA, resulting in potentially avoidable charges. Conversely, 84% of patients with confirmed MH underwent no further evaluation.</p><p><strong>Conclusion: </strong>31% of positive urine dipstick results were not followed by a confirmatory MUA, and 84% of patients with a positive MUA underwent no additional evaluation. These shortfalls point to gaps in the implementation of guideline-based care for MH. Future work should test targeted decision-support tools and simplified referral pathways to improve adherence and patient outcomes.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urology.2025.09.007","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To evaluate adherence to the 2025 AUA/SUFU microhematuria (MH) guideline, which requires confirmatory microscopic urinalysis (MUA ≥3 RBC/HPF) after a positive dipstick.
Materials and methods: TriNetX Research Network data (109 US health systems) were queried for adults aged 18-90 years with an initial positive dipstick from July 2020 to February 2025. Patients with gross hematuria, urinary tract infections, and kidney and/or ureteral calculi, cystitis, proteinuria, dysuria, and pregnancy diagnoses were excluded. Patients were stratified into three cohorts: no MUA, negative MUA, and positive MUA. We recorded the use of computed tomography (CT) urography, magnetic resonance imaging (MRI) urography, renal ultrasound, or cystoscopy within 6 months of positive dipstick.
Results: Among 37,300 eligible patients, 25,904 (69%) received MUA and 11,396 (31%) did not. MUA was positive in 9913 cases (38%) and negative in 15,991 (62%). Downstream testing followed 7.5% of dipstick-only cases, 16.1% of negative-MUA cases, and 16.3% of positive-MUA cases. In total, 855 procedures were performed without any MUA and 2575 after a negative MUA, resulting in potentially avoidable charges. Conversely, 84% of patients with confirmed MH underwent no further evaluation.
Conclusion: 31% of positive urine dipstick results were not followed by a confirmatory MUA, and 84% of patients with a positive MUA underwent no additional evaluation. These shortfalls point to gaps in the implementation of guideline-based care for MH. Future work should test targeted decision-support tools and simplified referral pathways to improve adherence and patient outcomes.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
