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Dr Whisnant's letter speaks directly to the problem of differentiating between "benign" hematuria after exercise and hematuria that is secondary to the organic pathological condition of the urologic system. I agree that features of the hematuria itself and the presence or absence of the symptoms are unreliable in establishing this differential.The clinician must exercise clinical judgment in deciding which patients with hematuria should be subjected to invasive testing. Exercise-related hematuria appears to be common, self-limited, and resultant from some form of mucosal trauma to the lower urinary tract. Dr Whisnant agrees that such cases are common. In our study we found 18% of marathoners positive for some degree of hematuria. If 40,000 runners participate in marathons in the coming year, as indicated by projections from the National Running Data Center, then as many as 8,000 persons might be expected to manifest this abnormality.I cannot agree that
Siegel AJ. Exercise-Related Hematuria-Reply. JAMA. 1979;242(15):1610. doi:10.1001/jama.1979.03300150016008