Background and aim: Microscopic hematuria (MH) is a common finding in urinalysis, existing in up to 30% of evaluated patients. Due to the relatively high rate of malignancy reported in patients with MH, a full urologi-cal evaluation to detect urothelial cancer is advocated by the American Urological Association (AUA) and the European Association of Urology (EAU) in woman with asymptomatic microhema-turia, once infection or urolithiasis were rule out. In contrast to the strict guidelines, our personal experience shows a very low rate of malignancies in women with asymptomatic microhematuria. Hence, the aim of our current study was to assess the rate of urothelial malignancies found during evaluation of asymptomatic women with recurrent MH in a pilot study. Methods: In the current retrospective study we retrieved the records of all women with asymptomatic MH who underwent an elective cystoscopy in our outpatient clinic during the years 2010-2015. We ex-amined the impact of their age, smoking status, upper tract imaging (sonography or CT-Urography), urine cytology results on cystoscopy results and pathological outcome. Results: 165 consecutive patients were included in the study: 1 had abnormal imaging, 2 women had abnor-mal urine cytology (atypia), and 2 had abnormal cystoscopy; 5 women were younger than 35, and all had a completely normal workup. None of the patients were diagnosed with urothelial cancer. Conclusions: A full urological investigation had a low yield in our cohort of women with asymptomatic microhe-maturia, and therefore may be unnecessary, especially in younger women.