OBJECTIVE: The purpose of this study was to assess microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms. STUDY DESIGN: We conducted a retrospective cohort analysis of women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy and biopsy results were recorded. RESULTS: Of 735 patients with irritative voiding symptoms, 264 (35.9%) had microscopic hematuria and 471 (64.1%) had no hematuria. Bladder cancer was detected in 3 women, for an overall detection rate of 0.4%. Microscopic hematuria, urgency, frequency, dysuria, nocturia, age, and tobacco use were not significantly associated with bladder cancer. CONCLUSION: In this cohort of women with irritative voiding symptoms, microscopic hematuria was not predictive for bladder cancer.