Updates to Microhematuria: AUA/SUFU Guideline (2025)

Abstract

Purpose: In 2023 the AUA in collaboration with the Society for Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) requested an Update Literature Review to incorporate new evidence generated since the 2020 publication of this Guideline. The resulting 2025 Microhematuria Guideline Amendment addresses updated recommendations to provide a clinical framework for the diagnosis, evaluation, and follow-up of microhematuria.

Materials and methods: In 2024, this Guideline was reviewed via the AUA Update Literature Review process, which identified 82 studies for full-text review that were published between December 2019 and June 7, 2024. Of those 82 studies, 23 met inclusion criteria for qualitative synthesis. The subsequent amendment is based on data released since the initial 2020 publication of this Guideline.

Results: The Panel developed evidence- and consensus-based statements based on an updated review to provide guidance on evaluation and management of microhematuria. These updates are detailed herein.

Conclusions: This update provides several new insights, including a revised risk stratification system, updated information regarding use of urine-based tumor markers and cytology, and new guidance on diagnosis and surveillance. This Guideline will require further review as the diagnostic and treatment options in this space continue to evolve.

Keywords: CT urogram; bladder cancer; cystoscopy; hematuria; urine markers; urothelial carcinoma.