[Asymptomatic microscopic haematuria: usually not a problem]

Asymptomatic microscopic haematuria is a common finding and can have many different causes. Only a small fraction of patients referred for microscopic haematuria have an underlying urological malignancy or serious nephrogenic disease. It is important that only those patients with microscopically confirmed microscopic haematuria are referred. Often no cause can be found even after thorough diagnostic work-up. The work-up of microscopic haematuria can include urethrocystoscopy, ultrasound, multi-phase CT and cytology. These procedures are not only costly, but can have associated health risks and may also cause patients anxiety and distress. There is no evidence to support the hypothesis that microscopic haematuria is the precursor of macroscopic haematuria, which is significantly more likely to have serious underlying causes. A diagnostic work-up should be initiated with caution.