Blanker Marco H
Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A1198.
In general practice, physicians are confronted with a newly diagnosed bladder cancer patient less than once a year. The role of general practitioners is restricted to just the initial phase of diagnosis and sometimes to the final, palliative stage of the disease. The diagnostic phase, as described in the guideline on urothelial carcinoma of the bladder, is hampered by the absence of clear signs and signals of bladder cancer. Painless gross haematuria is the most important clinical sign with a high predictive value, especially in older men. The value of microscopic haematuria is unclear and most patients with microscopic haematuria do not have a malignancy. Yet despite this, current guidelines still advise additional tests for all types of haematuria. However, we recommend that these patients are not subjected to such tests until their added value has been demonstrated.
在一般医疗实践中，医生每年遇到新诊断出的膀胱癌患者不到一例。全科医生的作用仅限于疾病诊断的初始阶段，有时还包括疾病的终末期姑息治疗阶段。正如膀胱尿路上皮癌指南中所述，膀胱癌诊断阶段因缺乏明确的体征和信号而受到阻碍。无痛肉眼血尿是最重要的临床体征，具有较高的预测价值，尤其是在老年男性中。镜下血尿的价值尚不清楚，大多数镜下血尿患者并无恶性肿瘤。然而，尽管如此，当前指南仍建议对所有类型的血尿进行进一步检查。不过，我们建议在证明这些检查的附加价值之前，不要让这些患者接受此类检查。
