Algorithm Deviates From the Guideline
The review article entitled “The Investigation of Hematuria” provides well founded recommendations for urological practices for how to investigate macro- or microhematuria (1). These insights should be rapidly integrated into future guidelines and implemented accordingly in specialist practices.
At the primary care level (general practitioners) with its own epidemiological classification numbers/performance indicators, however, the recently revised guideline from the German College of General Practitioners and Family Physicians (DEGAM) provides an algorithm to inform and direct medical practice (2) that deviates from the recommendations in the article in the context of non-visible hematuria (“microhematuria”). In this guideline, the recommendation is for risk assessment on the basis of the medical history, focusing on rapid urine testing—opportunistic screening is rejected in accordance with international recommendations—on shared decision making between patient and doctor for further diagnostic evaluation. Patient information complements the guideline and is intended to convey the fundamentals in a clear fashion, so as to enable considered decision making.
(Increased) cooperation of the specialist disciplines on the basis of scientifically sound guidelines would make a sustained positive contribution to the quality of care.
Dr. med. Armin Mainz
Conflict of interest statement
Dr. Mainz has received honoraria from the specialist society “German College of General Practitioners and Family Physicians” for developing guidelines.
|1.||Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Dräger BJ, Grimm MO: The investigation of hematuria. Dtsch Arztebl Int 2018; 115: 801–7 VOLLTEXT|
|2.||AWMF: Leitlinie „Hämaturie, nicht-sichtbare“. 053 – 028. Aktualisierte Fassung, Stand 2018. www.awmf.org/leitlinien/detail/ll/053–028.html (last accessed on 19 February 2019).|