American Urogynecologic Society

View all recommendations from this society

Released June 24, 2020

Do not routinely perform cystoscopy or imaging in asymptomatic, never-smoking women younger than 50 years with microscopic hematuria who have less than 25 RBC/HPF.

Asymptomatic hematuria in women is common but less likely to be associated with a urinary tract malignancy compared to men. Data support
changing the evaluation requirements for microscopic hematuria in this low-risk group of women. Organizations which do not risk-stratify based
on gender may continue to recommend more aggressive diagnostic evaluation in low-risk women.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Clinical Practice Committee of the American Urogynecologic Society (AUGS) reviewed clinical evidence to identify possible topics along with suggestions for possible topics from the AUGS Board of Directors. By consensus, the Clinical Practice Committee selected the top five most overused tests within specified parameters. Additional input was sought from the AUGS Board of Directors and incorporated. The final list was reviewed and approved by the AUGS Board of Directors.

AUGS’ listing of board and committee members and conflict of interest policy can be found at


Committee Opinion No. 703: Asymptomatic Microscopic Hematuria in Women. Obstetrics & Gynecology 2017 Jun;129(6):1153-4.

American Urogynecologic Society Systematic Review: Microscopic Hematuria as a Screening Tool for Urologic Malignancies in Women. Jeppson PC, Jakus-Waldman S1, Yazdany T2, Schimpf MO3, Ferzandi TR4, Yurteri-Kaplan LA5, Knoepp L6, Mamik M7, Resnick HE8, Ward RM9; American Urogynecologic Society Systematic Review Committee.Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, Messing EM, Miller SD, Peterson AC, Turk TM, Weitzel W; American Urological Association. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. Journal of Urology. 2012 Dec;188(6 Supplement):2473-81. (reviewed and reaffirmed in 2016)

Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK. Evaluation of microscopic hematuria and risk of urologic cancer in female patients. American Journal of Obstetrics & Gynecology 2017 Feb;216:146.e1–7.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CAL Cancer Journal for Clinicians 2017 Jan;67:7–30.