Blood in my urine on dipstick? evaluation necessary: Dr. Grotas 212-844-8942
This article in the journal of urology highlights the need to repeat ruine test
when a dipstick urine test shows blood.
Formal urinalysis with a microscope and a urine cytology can be done before any
invasive tests need to be done.
If you have microscopic hematuria a Ct-scan ( xray tests) or ultrasound
and cystoscopy ( camera test ) fiber optic scope is placed into the penis or female urethra to inspect the bladder.
This study showed that dip stick tests caused invasive workups when urine tests should have been send for microscopic analysis first.
dipstick analysis is very good at determining urinary tract infection but may have a trace of blood without a urologic hematuria problem
Dr. Grotas offers state of the art diagnostic testing without unnecesary tests.
call today to make an appointment if you have hematuria!!
Volume 183, Issue 2, Pages 560-565 (February 2010)
Dipstick Pseudohematuria: Unnecessary Consultation and Evaluation
Pravin K. Rao, Tianming Gao, Marc Pohl, J. Stephen Jones‡
Received 29 June 2009 published online 16 December 2009.
Purpose
While many primary care providers advocate routine screening urinalyses, a heme positive dipstick test often leads to a false-positive diagnosis of hematuria, or pseudohematuria. Thus, American Urological Association guidelines recommend urological evaluation for asymptomatic patients only for at least 3 red blood cells per high power field in 2 of 3 microscopic urinalyses. We determined the percentage of patients referred for asymptomatic hematuria undergoing unnecessary consultation and studies.
Materials and Methods
Patients were retrospectively identified if seen for initial consultation associated with CPT 599.7X, hematuria. Among these patients those referred for evaluation of asymptomatic nonmacroscopic hematuria were identified, and referral patterns, ancillary tests, procedures and findings were examined.
Results
Of 320 new patient visits with diagnosis code 599.7X, 91 were referred for asymptomatic, nonmacroscopic hematuria. Of these patients only 37 (41%) had microscopic urinalyses before referral and only 22 (24%) had microscopic urinalyses showing 3 or more red blood cells per high power field. Of the 69 patients referred without confirmed microhematuria approximately 25% had true microhematuria and 15 with no true hematuria had undergone imaging before referral. The Medicare reimbursement value for the evaluation of these 69 patients was $44,901. Of these patients 35 underwent cystoscopy and only 1 (with true microhematuria) had a malignancy.
Conclusions
Positive dipstick heme tests should always be confirmed by microscopic urinalysis before urological referral or evaluation. Education of referring physicians regarding the American Urological Association guidelines could possibly help limit costly and potentially harmful, unnecessary evaluation of patients without true microhematuria.
