Timeline for Resolution of Hematuria Following Treatment of Urinary Tract Infection and Implications for Confirmatory Testing

Objective To determine when to retest urine microscopy (UA) following antibiotic treatment in patients who have microhematuria (MH) attributable to urinary tract infection (UTI). Methods Retrospective cohort review of the TriNetX database from 2004 to 2024 was performed. Patients aged 18-90 years old with UA showing ≥3 red blood cells per high-powered field (RBC/HPF) and concurrent UTI treated by antibiotics, with repeat UA showing negative MH within 1 year, were analyzed. Primary endpoints were median days to negative UA following UTI treatment. Results 21,221 patients met criteria (14,467 females and 6752 males). Resolution of hematuria occurred in 38% at 30 days, 50% at 60 days (median), and 75% at 180 days. Severity of RBC/HPF at UTI was not associated with shorter median days to MH resolution (3-10 RBC/HPF 61 days vs ≥26 RBC/HPF 61 days). Older patients and males both had significantly earlier resolution of MH ( P <.0001). Earlier rechecking was associated with greater likelihood of recurrent positive MH on recheck in all associated risk groups. Delaying UA after 4 weeks does not increase the likelihood of negative UA above 80%, but retesting after 12 weeks optimizes the rate of positive UA to less than 21%. Conclusion Repeat UA should be done around 12 weeks to allow natural resolution of MH attributable to UTI.