Khadra M H, Pickard R S, Charlton M, Powell P H, Neal D E
Department of Urology, Freeman Hospital, University of Newcastle upon Tyne, United Kingdom.
J Urol. 2000 Feb;163(2):524-7.
The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVP) and cystoscopy. Some have suggested that ultrasound of the upper urinary tract is adequate and that cystoscopy is not necessary in younger patients with microscopic hematuria. We ascertain whether a less intensive algorithm could be adopted while retaining diagnostic efficacy.
A total of 1,930 patients were enrolled prospectively in the study at a hematuria clinic between October 1994 and March 1997. Evaluation consisted of basic demographics, history and examination, routine blood tests, urinalysis and cytology. All patients underwent plain abdominal radiography, renal ultrasound, IVP and flexible cystoscopy.
A total of 1,194 males and 736 females with a mean age of 58 years (range 17 to 96) were included in the study. Overall, 61% of patients had no basis found for hematuria, 12% had bladder cancer, 13% had urinary tract infection and 2% had stones. Kidney and upper tract tumors were noted in 14 patients (0.7%), including 4 who presented with microscopic hematuria. If only ultrasound or IVP had been performed 4 of these cases would have been missed. Of 982 patients presenting with microscopic hematuria 51 had cancer. Bladder cancer was found in 7 patients younger than 40 years.
Our findings suggest that cystoscopy cannot be safely avoided even in younger patients with microscopic hematuria. Only a combination of ultrasound and IVP detected all upper tract tumors.
血尿常见的诊断算法包括排泄性尿路造影（IVP）和膀胱镜检查。一些人认为上尿路超声检查就足够了，对于患有镜下血尿的年轻患者，膀胱镜检查并非必要。我们要确定在保持诊断效力的同时是否可以采用一种强度较低的算法。
1994年10月至1997年3月期间，共有1930例患者在一家血尿诊所前瞻性入组该研究。评估包括基本人口统计学、病史和体格检查、常规血液检查、尿液分析和细胞学检查。所有患者均接受了腹部平片、肾脏超声、IVP和软性膀胱镜检查。
该研究纳入了1194例男性和736例女性，平均年龄58岁（范围17至96岁）。总体而言，61%的患者未发现血尿的病因，12%患有膀胱癌，13%患有尿路感染，2%患有结石。14例患者（0.7%）发现有肾脏和上尿路肿瘤，其中4例表现为镜下血尿。如果仅进行超声或IVP检查，这些病例中有4例会被漏诊。在982例表现为镜下血尿的患者中，51例患有癌症。在7名年龄小于40岁的患者中发现了膀胱癌。
我们的研究结果表明，即使对于患有镜下血尿的年轻患者，也不能安全地省略膀胱镜检查。只有超声和IVP联合检查才能发现所有上尿路肿瘤。
