Evaluation of the patient with hematuria

Blood in voided urine, or hematuria, can originate from anywhere along the urinary tract and may be the only presenting sign of significant urologic disease. Refinements in imaging modalities and advances in endoscopic technologies have made the outpatient evaluation of hematuria simple, safe, and cost effective. An understanding of the potential etiologies for hematuria and diagnostic regimen by the primary care physician results in appropriate referral to a urologist and ensures that optimal treatment decisions, if needed, can be made in a timely manner. Gross hematuria typically brings the patient promptly to the physician and little debate surrounds the need for a thorough evaluation. Indeed, visible blood in the urine is the presenting symptom in up to 85% of patients with bladder cancer and 40% of patients with renal cell carcinoma [1,2]. The proper evaluation of microscopic hematuria remains a matter of considerable debate, however, because of the fact that it is a common problem (representing 6% of new patients seen by urologists) and that some patients have no identifiable etiology [3]. The challenge has been to determine the best strategy to identify patients with significant disease while minimizing the cost and morbidity of unnecessary tests and procedures. This article reviews the current literature and proposes the optimal, modern evaluation for patients presenting with hematuria. Detection and definitions of hematuria The identification of an abnormal quantity of red blood cells (RBCs) in the urine relies on the accurate detection of blood and the definition of what