Hematuria as a Marker of Occult Urinary Tract Cancer

Publication Date: April 1, 2016
Last Updated: March 14, 2022

High-Value Care Advice

Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria.

Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.

Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.

Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited.

Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.

Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.

Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.

Recommendation Grading




Hematuria as a Marker of Occult Urinary Tract Cancer

Authoring Organization

Publication Month/Year

April 1, 2016

Last Updated Month/Year

June 1, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

The presence of blood in the urine, or hematuria, is a common finding in clinical practice and can sometimes be a sign of occult cancer. This article describes the clinical epidemiology of hematuria and the current state of practice and science in this context and provides suggestions for clinicians evaluating patients with hematuria.

Target Patient Population

Patients with hematuria

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D055088 - Early Detection of Cancer, D000076862 - Diagnostic Screening Programs, D006417 - Hematuria, D001743 - Urinary Bladder, D014551 - Urinary Tract


cancer, hematuria, occult cancer