Nielsen Contributes to New AUA Hematuria Guidelines

The 2020 American Urological Association Guideline for Evaluation of Hematuria lays out individualized, risk-stratified recommendations to promote early identification of genitourinary cancers while minimizing harms and costs from potentially avoidable imaging and invasive testing. Matthew Nielsen, MD, professor and interim chair of the UNC Department of Urology, was a panelist and contributing author.

Nielsen Contributes to New AUA Hematuria Guidelines click to enlarge Matthew Nielsen, MD
Nielsen Contributes to New AUA Hematuria Guidelines click to enlarge Hematuria Evaluation Algorithm accompanying new AUA Guideline (full text available at https://www.auanet.org/guidelines/microhematuria)

Dr. Matthew Nielsen, professor and interim chair of the UNC Department of Urology, was a panelist and contributing author to the American Urological Association’s new 2020 Guideline for the evaluation of hematuria, released this week. The guideline was presented by panel co-chairs at the AUA Live Virtual Experience on Saturday, June 27.

Hematuria--blood in the urine--is a common finding in clinical practice, with over 2 million American patients referred each year for evaluation, representing one of the most common diagnoses seen by urologists. The AUA panel aimed to develop and disseminate clear guideline recommendations for the evaluation of hematuria. This work sought to mitigate potentially avoidable risks and costs associated with the over-evaluation of patients at low risk for malignancy, while at the same time addressing the delays in diagnosis of important urologic conditions caused by widespread under-evaluation and variations in care. The new 2020 AUA Guideline provides an individualized, risk-stratified approach to hematuria evaluation based on the patient’s risk of harboring a urinary tract cancer.

Nielsen’s work in this area started with a collaboration with the American College of Physicians’ High Value Care Task Force, published in 2016. This effort highlighted unexplained variation in care and raised questions related to potentially avoidable costs and harms from existing recommendations at that time, which recommended uniform evaluation with CT for all adults with hematuria. Last summer, a team of investigators from UNC published a simulation modeling study in JAMA Internal Medicine examining tradeoffs of harm, benefit and cost associated with various strategies for hematuria evaluation, finding substantial potentially avoidable costs and harms from radiation exposure with the previously-recommended uniformly intensive approach.

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