AUA 2025 guidelines help predict urothelial neoplasm risk in MH patients

The 2025 guidelines set by the American Urological Association (AUA) improve stratification of patients with microscopic hematuria (MH) into risk groups for urothelial cancer, but not renal cortical neoplasms of any kind, according to a study.

"Furthermore, the variables used in the construction of this model were also validated for urothelial cancers but not renal neoplasms,” the authors said. 

A total of 4,550 patients with asymptomatic MH, evaluated from 2010 to 2023 who underwent both imaging and cystoscopy, were included in this retrospective analysis. The authors classified patients into risk groups based on the AUA 2025 guidelines to predict the presence of total neoplasms, particularly urothelial and renal cortical neoplasms and to validate specific clinical components.

Overall, neoplasm incidence among patients was 3.1 percent, with urothelial and renal cortical neoplasms at 1.5 percent and 1.6 percent, respectively (1.3 percent angiomyolipomas [AML] and 0.35 percent non-AML renal masses).

The incidence of urothelial malignancy was higher among high-risk patients then intermediate- and low-risk individuals (3.8 percent vs 0.8 percent and 0.2 percent), while the incidence of renal neoplasms of any type did not differ significantly across risk groups.

Age, male gender, smoking pack years, and urinary red blood cells count significantly predicted urothelial malignancies, validating the AUA 2025 guidelines. However, only male gender and smoking history predicted non-AML renal tumours.

Notably, women were not classified as high risk based on age ≥60 years in the recent amendment. However, the current study found that women aged ≥70 years had a 2.2-percent incidence of bladder cancer.

This finding suggests that “women older than 70 years should be considered high risk,” the authors said.

“The lack of predictive value for renal cortical neoplasms suggests areas for guideline realignment, specifically the type and goal of renal imaging,” they added.