Thank you Kusuma and Dr. Bollan for working through a case of microscopic hematuria today. During an Emergency Department evaluation, incidental microscopic hematuria was identified in an older man. With multiple risk factors for urothelial malignancy, he underwent CT urogram and cystoscopy. Ultimately, his microscopic hematuria was attributed to renal stones, but it’s important to exclude bladder cancer in these patients. Don’t order urine cytology! The American Urological Association guidelines recommend against this test due to its poor sensitivity.