Updates to Microhematuria: AUA and SUFU Guidelines Update 2025

Posted by Diane Newman, DNP ANP-BC FAAN FAUNA BCB-PMD | Mar 2025

Diane K. Newman, DNP, ANP-BC, FAUNA, FAAN, presents “Updates to Microhematuria: AUA and SUFU Guidelines Update 2025.”

How to cite: Newman, Diane K. “Updates to Microhematuria: AUA and SUFU Guidelines Update 2025.” February 19, 2025. Accessed Apr 2025. https://grandroundsinurology.com/updates-to-microhematuria-aua-and-sufu-guidelines-update-2025/

Updates to Microhematuria: AUA and SUFU Guidelines Update 2025 – Summary

Diane K. Newman, DNP, ANP-BC, FAUNA, FAAN, Urology Nurse Practitioner, Adjunct Professor of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, a leading urology nurse practitioner with over 35 years of experience, discusses the newly released 2025 AUA/SUO/SUFFU guidelines on microhematuria evaluation. In this 14-minute presentation, Newman offers timely insights for urology providers.

The update presents a refined risk stratification system, new recommendations for urine-based tumor markers, and revised protocols for diagnosis and surveillance. A critical point addressed is the ongoing inconsistency among existing guidelines, particularly regarding definitions and evaluation standards for microhematuria. Emphasis is placed on the concerning underutilization of cystoscopy, despite its established role as the most effective modality for detecting bladder cancer. Microhematuria remains defined as greater than three red blood cells per high-powered field on microscopic urinalysis. Initial evaluation must include a comprehensive history, physical examination, blood pressure measurement, and serum creatinine testing.

Risk classification into low, intermediate, or high categories is based on age, smoking history, red blood cell count, and other malignancy risk factors. For low-risk patients, guidelines recommend repeat urinalysis within six months without immediate imaging or cystoscopy. Intermediate-risk individuals should undergo renal ultrasound and cystoscopy, with optional use of urine-based tumor markers to inform decisions when cystoscopy is deferred. High-risk patients require both cystoscopy and upper tract imaging, with prioritization based on age and cumulative smoking exposure.

Newman details the interpretation of urinalysis findings and urine color variations, offering practical tools for clinical assessment. Shared decision-making is recommended for determining follow-up strategies after a negative initial workup. The presentation underscores a need for greater adherence to cystoscopic evaluation in at-risk populations.

This update offers an essential opportunity to stay current with evolving microhematuria management standards and apply best practices in clinical settings.

About The Author

Diane Newman, DNP ANP-BC FAAN FAUNA BCB-PMD

Dr. Diane K. Newman is an Adjunct Professor of Surgery, Perelman School of Medicine, University of Pennsylvania. She is the former Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, Penn Medicine, in Philadelphia. She is a Fellow of the American Academy of Nursing and the Academy of Urologic Nurses and Associates. She is certified as an adult nurse practitioner by the American Nurses Credentialing Center and Board Certified in Biofeedback for Pelvic Muscle Dysfunction by the Biofeedback Certification Institute of America.

Dr. Newman has 35+ years of experience practicing as a urology advanced practice provider and continence nurse specialist. Her clinical expertise involves the evaluation, treatment, and management of urinary incontinence, bladder dysfunction, and related problems, including the use of catheters and other devices in the management of bladder and pelvic floor conditions. Throughout her career, she has evaluated and treated men and women with urologic disorders in multiple settings: acute care, long-term, and home care, with 23 years in an ambulatory practice at the Division of Urology at the University of Pennsylvania.

Dr Newman is an internationally known educator. She has been at the forefront of urology nursing education on conservative treatments for lower urinary tract dysfunction. She developed a curriculum on urology nursing, training nurses in Hong Kong and Mainland China from 1994 to the present. Since the start of her career in urology, she has conducted NIH and industry-funded research in several urologic areas: incontinence, overactive bladder, pelvic floor disorders, use of catheters, and other devices. She was the lead editor of the 1^st edition of SUNA’s Core Curriculum for Urologic Nursing and Clinical Application of Urologic Catheters, Devices and Products.

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