Defining the Prevalence of Asymptomatic Microscopic Hematuria Among Women With Symptomatic Pelvic Organ Prolapse: Implications for Recommending Subsequent Diagnostic Evaluation

Objective: To evaluate the prevalence of asymptomatic microscopic hematuria (AMH) in women presenting with POP, as well as the relationship of POP stage with AMH. Materials and Methods: Charts of women evaluated in a Female Pelvic Medicine and Reconstructive Surgery clinic between January 2015 and July 2016 were retrospectively reviewed. The prevalence of AMH (≥3 red blood cells per high-powered field on 1 urinalysis) was compared for women with symptomatic POP and those with urinary incontinence (UI) without symptomatic POP. Patient features were compared using chi-square and rank sum tests. Logistic regression was used to evaluate the association of patient factors and AMH. Results: Overall, 455 of the 498 patients evaluated (91%) had a urinalysis with microscopy. The prevalence of AMH was 3.3% (15 of 455), and was not significantly different between women presenting for prolapse (9 of 264, 3.4%) vs UI (6 of 191, 3.1%; P = .87). The presence of stage ≥2 anterior prolapse was not associated with the risk of AMH (P = .91). Voided vs catheterized specimens were associated with an increased rate of AMH (15.2% vs 2.4%; P = .003). Subsequent hematuria evaluation identified 2 cases of bladder cancer, a urethral mesh erosion, and an asymptomatic kidney stone, with the remaining evaluations negative. Conclusion: We found a prevalence of AMH in women with POP lower than previously reported, and consistent with patients presenting for UI. As such, AMH noted among women with POP should not be ascribed solely to the presence of prolapse.