The real time confocal scanning laser microscope provides excellent three-dimensional images free of out-of-focus information. The objective of this study was to evaluate the usefulness of the laser microscope for the diagnosis of microhematuria. Characteristics of the test were evaluated in 81 patients with definite causes of hematuria. 30 erythrocytes in urinary sediments were examined for each patient, and those in whom less than 20% of the erythrocytes were poikilocytes were considered to have urological diseases and those in whom 80% or more of the erythrocytes were poikilocytes to have nephritis. According to these criteria, the sensitivity and the specificity of the examination to nephritis were 100 and 98.1%. 91.4% of the patients with urological disease had the nonglomerular type. The time required for the examination was less than 2-5 min in samples containing 1-3 erythrocytes in one field under an ordinary light microscope (x400).