Hicks Derek, Li Chi-Ying
Department of Emergency Medicine, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK.
Emerg Med J. 2007 Jun;24(6):385-90. doi: 10.1136/emj.2006.042457.
Macroscopic haematuria is a commonly seen condition in the emergency department (ED), which has a variety of causes. However, most importantly, macroscopic haematuria has a high diagnostic yield for urological malignancy. 30% of patients presenting with painless haematuria are found to have a malignancy. The majority of these patients can be managed in the outpatient setting. This review of current literature suggests a management pathway that can be used in the ED. A literature search was done using Medline, PubMed and Google. In men aged >60 years, the positive predictive value of macroscopic haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%. In terms of the need for follow-up investigation, a single episode of haematuria is equally important as recurrent episodes. Baseline investigation in the ED includes full blood count, urea and electrolyte levels, midstream urine dipstick, beta human chorionic gonadotrophin, and formal microscopy, culture and sensitivities. Treatment of macroscopic haematuria aims at RESP--Resuscitation, Ensuring, Safe and Prompt. Indications for admission include clot retention, cardiovascular instability, uncontrolled pain, sepsis, acute renal failure, coagulopathy, severe comorbidity, heavy haematuria or social restrictions. Discharged patients should drink plenty of clear fluids and return for further medical attention if the following occur: clot retention, worsening haematuria despite adequate fluid intake, uncontrolled pain or fever, or inability to cope at home. Follow-up by a urological team should be promptly arranged, ideally within the 2-week cancer referral target.
肉眼血尿是急诊科常见的病症，病因多样。然而，最重要的是，肉眼血尿对泌尿系统恶性肿瘤具有较高的诊断价值。30%表现为无痛性血尿的患者被发现患有恶性肿瘤。这些患者中的大多数可在门诊进行处理。对当前文献的综述提出了一种可在急诊科使用的处理途径。通过医学数据库（Medline）、医学期刊数据库（PubMed）和谷歌进行了文献检索。在60岁以上的男性中，肉眼血尿对泌尿系统恶性肿瘤的阳性预测值为22.1%，在同年龄女性中为8.3%。就后续检查的必要性而言，单次血尿发作与复发性发作同样重要。急诊科的基线检查包括全血细胞计数、尿素和电解质水平、中段尿试纸检测、β-人绒毛膜促性腺激素以及正式的显微镜检查、培养和药敏试验。肉眼血尿的治疗目标是RESP——复苏、确保、安全和迅速。入院指征包括血块潴留、心血管不稳定、疼痛无法控制、脓毒症、急性肾衰竭、凝血功能障碍、严重合并症、大量血尿或社会限制因素。出院患者应大量饮用清澈液体，如果出现以下情况应返回接受进一步治疗：血块潴留、尽管摄入足够液体但血尿仍加重、疼痛或发热无法控制或在家中无法应对。应及时安排泌尿外科团队进行随访，理想情况下应在两周的癌症转诊目标时间内。
