CONTEXT Non-visible haematuria (NVH) is a common finding and may indicate undiagnosed urological cancer. The optimal investigation of NVH is unclear, given the incidence of cancer and the public health implications of testing all individuals with this finding. OBJECTIVE We review contemporary literature to determine the association of NVH with the diagnosis of bladder cancer (BC), upper tract urothelial carcinoma (UTUC), and kidney cancer (KC). EVIDENCE ACQUISITION A systematic review of original articles in English was completed in May 2019. Meta-analyses for the diagnostic accuracy of NVH and urine cytology were performed. EVIDENCE SYNTHESIS We screened 1529 articles and selected 78 manuscripts that fulfilled our inclusion criteria for narrative synthesis. Forty manuscripts were eligible for a meta-analysis (reporting 19 193 persons). The likelihood of a urological cancer in patients with NVH increased with age (<1% in those aged <40yr), male sex, and cigarette smoking. Less than 1% of patients are found to have a urological cancer after a negative NVH evaluation. Cancer detection rates in individuals evaluated for NVH ranged from 0% to 16% for BC in 37 studies, 0% to 3.5% for UTUC in 30 studies, and 0% to 9.7% for KC in 29 studies. Substantial statistical heterogeneity was present for the meta-analysis of detection rates. CONCLUSIONS We present an up-to-date review of the association of NVH with the diagnosis of BC, UTUC, and KC. Individuals with dipstick positive haematuria aged ≥40yr, who have had potential precipitating causes excluded, should undergo an evaluation. Re-evaluation of patients with unremarkable initial investigations should be performed in high-risk patients or if new symptoms occur. PATIENT SUMMARY One in five people have microscopic traces of blood in their urine. This is an important indicator of urological cancer. Investigating all patients is uncomfortable and expensive. We evaluate the risk of cancer and estimate risks to groups of individuals.

中文翻译：

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膀胱，上呼吸道和肾脏癌的不可见血尿检测：更新的系统评价和荟萃分析。

语境非可见性血尿（NVH）是一个常见发现，可能提示未诊断的泌尿外科癌症。鉴于癌症的发生率以及对所有发现进行测试的个人的公共卫生影响，目前尚不清楚NVH的最佳调查方法。目的我们综述当代文献以确定NVH与膀胱癌（BC），上尿路尿路上皮癌（UTUC）和肾癌（KC）的诊断之间的关系。证据获取已于2019年5月完成对英文原件的系统评价。对NVH和尿液细胞学诊断准确性进行了荟萃分析。证据合成我们筛选了1529篇文章，选择了78篇满足叙事合成纳入标准的手稿。有40篇手稿符合条件进行了荟萃分析（报告19 193人）。NVH患者发生泌尿系统癌症的可能性随年龄（<40岁的人群<1％），男性和吸烟而增加。NVH评估阴性后，发现少于1％的患者患有泌尿系统癌症。在37项研究中，评估NVH的个体的癌症检出率在BC中为0％至16％，在30项研究中UTUC为0％至3.5％，在29项研究中为KC为0％至9.7％。存在大量统计学异质性，用于检测率的荟萃分析。结论我们提供了关于NVH与BC，UTUC和KC的诊断的最新综述。年龄≥40岁的量油尺阳性血尿的个体，可能有潜在的诱发原因，应接受评估。对高危患者或出现新症状的患者，应先进行无明显初步检查的患者重新评估。患者总结五分之一的人尿液中有微量的血液。这是泌尿系统癌症的重要指标。对所有患者进行调查既不舒服又昂贵。我们评估癌症的风险，并估计对个人群体的风险。