BackTable Urology Ep. 282 Updates to Microhematuria Workup Guidelines with Dr. Daniel Barocas
Dec 30, 2025
Dr. Daniel Barocas, urologic oncologist and guideline contributor at Vanderbilt, walks through the 2025 microhematuria guideline changes. He explains revised risk groups and which patients may avoid immediate workup. He discusses imaging tradeoffs and expanding use of urinary biomarkers for intermediate-risk evaluations. The conversation highlights practical impacts on patient evaluation and shared decision-making.
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Low-Risk Patients Need Recheck Not Immediate Scope
- The low-risk group has a bladder cancer risk between 0 and 0.4%, so immediate cystoscopy and renal ultrasound are no longer recommended.
- Instead, repeat urinalysis within six months and re-stratify if hematuria persists.
Sex Alters Risk Categorization
- Women have a 3–4x lower risk of bladder cancer than men, and age alone shouldn't place women in the high-risk category.
- Prove and treat presumed UTIs and recheck urinalysis before attributing hematuria to infection in women.
Use A Broad Risk Checklist
- Use sex, age, smoking, degree of hematuria, gross hematuria history, and persistence to stratify risk.
- Consider specific exposures, prior radiation/chemotherapy, Lynch syndrome, and familial RCC syndromes when deciding imaging.