Methods and current significance of the evaluation of microscopic haematuria

Haematuria is the main symptom of malignant diseases of the urinary tract. Hence urine analysis for the detection of microscopic haematuria is an accepted diagnostic procedure in daily urologic practice. Until now there are neither international nor national agreements relating to the definition of microscopic haematuria, the choice of verification procedures and a diagnostic algorithm. As there are diverse reasons for microscopic haematuria the extent of continuative diagnostics should be adapted to the existence of risk factors for a clinically apparent disease. Low-risk patients with asymptomatic microscopic haematuria do not necessarily have to undergo primary cystoscopy if there are no pathological findings on urine cytology or ultrasound examination. Microhaematuria in high-risk patients should lead to a more intensive evaluation of the urinary tract, which should include cystoscopy and imaging of the upper urinary tract. In the diagnostics of microhaematuria you have to be aware of that intermittent bleeding is often characteristic of urothelial malignancies. Therefore, a single negative urine analysis should not lead to abandonment of further diagnostic procedures.