Tan P K, Chang H C, Sitoh Y Y
Department of Surgery, Tan Tock Seng Hospital, Singapore.
Singapore Med J. 1998 Nov;39(11):501-3.
To audit and study the practicality of an integrated Haematuria Clinic as a one-stop assessment centre for the investigations of patients presenting with haematuria.
A weekly clinic was organised to facilitate consultation, intravenous urogram and flexible cystoscopy for patients with haematuria. A protocol was set up and data on symptoms, types of haematuria, results of the investigations and outcomes were collected.
About half of all the patients seen in this clinic were found to harbour urological lesions; of which urolithiasis (20.4%) and urological malignancies (14.2%) were the most common lesions identified. Transitional cell carcinoma of the bladder was the most common malignancy diagnosed (8%). Significantly, 2 of 9 (22.2%) bladder cancers were found on cystoscopy and missed on the cystogram phase of the intravenous urogram. Ten urological lesions would have been missed if cystoscopies were not performed. Conversely, in 14 patients, cystoscopy could be avoided because their intravenous urograms identified lesions sufficiently to allow for definitive treatment.
The need and types of investigation for patients with haematuria are evolving. We recommend intravenous urogram and flexible cystoscopy as the standard investigations and caution against ignoring microscopic haematuria. These assessments can be organised into an integrated clinic improving deliverance of clinical care; which may result in better patient compliance for investigations and earlier detection and treatment of urological lesions presenting as haematuria.
审核并研究综合血尿诊所作为血尿患者一站式评估中心的实用性。
每周组织一次诊所，为血尿患者提供咨询、静脉肾盂造影和软性膀胱镜检查服务。制定了一项方案，并收集了有关症状、血尿类型、检查结果和治疗结果的数据。
在该诊所就诊的所有患者中，约有一半被发现患有泌尿系统病变；其中尿路结石（20.4%）和泌尿系统恶性肿瘤（14.2%）是最常见的病变。膀胱移行细胞癌是最常见的诊断出的恶性肿瘤（8%）。值得注意的是，9例膀胱癌中有2例（22.2%）在膀胱镜检查时被发现，而在静脉肾盂造影的膀胱造影阶段被漏诊。如果不进行膀胱镜检查，将会漏诊10例泌尿系统病变。相反，在14例患者中，可以避免进行膀胱镜检查，因为他们的静脉肾盂造影已充分识别出病变，足以进行确定性治疗。
血尿患者的检查需求和类型正在不断变化。我们建议将静脉肾盂造影和软性膀胱镜检查作为标准检查，并提醒不要忽视镜下血尿。这些评估可以整合到一个综合诊所中，以改善临床护理的提供；这可能会使患者对检查的依从性更好，并能更早地发现和治疗表现为血尿的泌尿系统病变。
