An Clemens, Jeong Jake, Chiu Cedrick, Gaston Evan, Kennedy Amanda, Sternberg Kevan
The Robert Larner M.D. College of Medicine at the University of Vermont Burlington Vermont USA.
Washington University School of Medicine Saint Louis Missouri USA.
J Gen Fam Med. 2024 Dec 10;26(1):73-78. doi: 10.1002/jgf2.740. eCollection 2025 Jan.
Our goal was to identify, and risk stratify primary care patients with microscopic hematuria (MH), describe the diagnostic evaluations they received, and determine whether the evaluations were consistent with the recommendations of the 2020 AUA/SUFU microscopic hematuria guidelines.
A retrospective review of patients presenting to primary care clinics with a diagnosis of MH was performed. The patient risk category was determined based on the 2020 AUA/SUFU guidelines. Diagnostic strategies were recorded, and guideline concordance was determined. Descriptive statistics were generated to describe outcomes.
A total of 368 patients had a diagnosis of MH; 267/368 (72.6%) patients had all pertinent data available for risk stratification. One-hundred and fifty-six (58.4) patients were high-risk and 55 (35.3%) had a urologic visit. Forty-one of the 55 (75%) were diagnostically evaluated of which 13 (31.7%) were in-line with guideline recommendations. Eighty-two (30.7%) patients were at intermediate risk of which 33 (40.2%) had a urology visit. Of these 33 intermediate-risk patients, 27 (81.8%) were diagnostically evaluated, five (18.5%) of which were in-line with guideline recommendations. Twenty-nine patients were low risk of which 4 (13.8%) had a urology visit. Three of the four patients seen by urology (75%) were evaluated with imaging studies and none received a cystoscopy.
Almost 60% of the patients in our cohort were high-risk according to the AUA/SUFU 2020 guidelines. Across all strata, the majority of patients lacked a urology visit and diagnostic evaluation consistent with guideline recommendations. Future efforts should ensure appropriate urologic referral and optimize initial diagnostic strategies for patients with MH.
我们的目标是识别原发性护理中患有镜下血尿（MH）的患者并进行风险分层，描述他们接受的诊断评估，并确定这些评估是否符合2020年美国泌尿外科学会（AUA）/泌尿外科学和男性学联合会（SUFU）镜下血尿指南的建议。
对到初级保健诊所就诊且诊断为MH的患者进行回顾性研究。根据2020年AUA/SUFU指南确定患者风险类别。记录诊断策略，并确定与指南的一致性。生成描述性统计数据以描述结果。
共有368例患者被诊断为MH；267/368（72.6%）例患者有所有可用于风险分层的相关数据。156例（58.4%）患者为高危患者，55例（35.3%）患者就诊于泌尿外科。55例患者中有41例（75%）接受了诊断性评估，其中13例（31.7%）符合指南建议。82例（30.7%）患者为中度风险，其中33例（40.2%）就诊于泌尿外科。在这33例中度风险患者中，27例（81.8%）接受了诊断性评估，其中5例（18.5%）符合指南建议。29例患者为低风险，其中4例（13.8%）就诊于泌尿外科。泌尿外科诊治的4例患者中有3例（75%）接受了影像学检查，无一例接受膀胱镜检查。
根据2020年AUA/SUFU指南，我们队列中近60%的患者为高危患者。在所有分层中，大多数患者未就诊于泌尿外科，也未接受符合指南建议的诊断评估。未来的工作应确保适当的泌尿外科转诊，并优化MH患者的初始诊断策略。
