Utility of Serial Urinalyses and Urinary Cytology in the Evaluation of Patients with Microscopic Haematuria

BACKGROUND: Serial urinalyses have been advocated when haematuria is suspected. OBJECTIVE: To determine the utility of serial urinalyses and urinary cytology in patients presenting for evaluation of microscopic haematuria. METHODS: Eighty-five patients with the diagnosis of microscopic haematuria were evaluated at a tertiary-care hospital. All patients had a comprehensive urologic evaluation. Clinic and hospital records were reviewed for key factors (e.g., demographic, pathology, radiologic findings and operative findings). RESULTS: One hundred ninety total urinalyses were reviewed. Eighty-eight (46%) urinalyses were classified as normal, 87 (46%) as haematuria (> 3 RBC/hpf), and 15 (8%) as pyuria/ bacteriuria. The initial urinalysis detected haematuria in 95% of the patients. The addition of the second and third urinalyses detected haematuria in the remaining 5% of the patients with haematuria. Aetiologic factors for microscopic haematuria include urolithiasis 15 (18%), infection 9 (11%) and bladder lesion/tumor 6 (7%). In this setting of microscopic haematuria, urinary cytology was not able to detect any of the five documented bladder tumors. Fifty-seven percent of patients had a negative haematuria evaluation. CONCLUSION: In the evaluation of the patient with microscopic haematuria, serial urinalyses may have a low yield. Further prospective studies are needed to further evaluate serial urinalyses in this cohort.