To evaluate urologic consultations, bladder cancer (BCa) distribution, and estimated costs of alternative evaluation strategies for microhematuria (MH) at a Veterans Affairs (VA) center. We retrospectively studied Veterans with MH at Jesse Brown VA (2021–2024). Patients were risk-stratified by MH severity (low: 3–10 red blood cells per high-powered field RBC/hpf, intermediate: 11-25, high: ≥26) and age (low: 18–39, intermediate: 40–59, high: ≥60). The primary outcome was urology consultation. BCa detection was assessed across risk groups, and procedural costs compared across guideline-based and alternative strategies. Among 1, 046 Veterans, 71. 6% received a urology consult. When stratified by MH-based risk, 69. 5% of low-risk, 70. 5% of intermediate-risk, and 75. 9% of high-risk patients received a consult. Neither MH- nor age-based risk predicted consultation. BCa was detected in 7 high-risk patients (0. 7%). Raising the diagnostic threshold to ≥26 RBC/hpf reduced total costs (382, 939 vs 1, 015, 029) but increased costs per patient evaluated (1, 201 vs 971). Urologic evaluation among Veterans with MH is common, yet BCa detection is low and concentrated in high-risk individuals. Current referral patterns may overuse resources for low-risk patients. Raising diagnostic thresholds and substituting ultrasound for CT in low-risk patients could reduce costs. Future multi-center studies should validate these findings and examine overuse of cystoscopy and imaging for low-risk patients.
Sridalla et al. (Sun,) studied this question.