Confirmatory Microscopic Urinalysis After Positive Dipstick Microhematuria: Adherence Patterns and Quality...

Area of Science:

• Urology
• Nephrology
• Health Services Research

Background:

• The 2025 AUA/SUFU guideline recommends confirmatory microscopic urinalysis (MUA) for positive urine dipstick results.
• Microhematuria (MH) evaluation is crucial for detecting underlying urologic conditions.

Purpose of the Study:

• To assess adherence to the 2025 AUA/SUFU guideline for microhematuria (MH) evaluation.
• To identify shortfalls in the diagnostic pathway following a positive urine dipstick test.

Main Methods:

• A retrospective analysis of the TriNetX Research Network database (109 US health systems) was conducted.
• Adults (18-90 years) with a positive urine dipstick from July 2020 to February 2025 were included, excluding specific conditions.
• Patients were categorized into no MUA, negative MUA, and positive MUA cohorts; downstream testing was recorded.

Main Results:

• 31% of patients with a positive dipstick did not undergo confirmatory MUA.
• Of those with confirmed MH (positive MUA), 84% received no further evaluation.
• Significant numbers of downstream procedures were performed without MUA or after negative MUA, suggesting potential overutilization.

Conclusions:

• There are significant gaps in implementing guideline-based care for microhematuria (MH).
• Low adherence to confirmatory MUA and lack of further evaluation after confirmed MH highlight implementation challenges.
• Targeted interventions, such as decision-support tools and streamlined referrals, are needed to improve MH guideline adherence and patient outcomes.