Department of Urology, University of Texas Southwestern Medical Center at Dallas, TX, USA.
Cancer. 2010 Jun 15;116(12):2954-9. doi: 10.1002/cncr.25048.
To determine whether high-risk patients with hematuria receive evaluation according to guideline recommendations.
We recently performed a screening study for bladder cancer using a urine-based tumor marker in 1502 subjects at high risk based on aged > or = 50 years, > or = 10-year smoking history, and/or a 15-year or more environmental exposure. We evaluated use of urinalysis (UA) within 3 years preceding the screening study. Chart review was performed to determine if this subset with microhematuria received any additional evaluation.
Of 1502 study participants, routine urinalysis was performed in 73.2% and 164 (14.9%) subjects had documented hematuria (>3 red blood cells / high-power field) before inclusion. Of these, 42.1% had no further evaluation. Additional testing included repeat urinalysis (36%), urine culture (15.2%), cytology (10.4%), imaging (22.6% overall: 15.9% computed tomography, 4.3% intravenous pyelography; 2.4% magnetic resonance imaging), and cystoscopy (12.8%). Three subjects with microscopic hematuria (2%) were subsequently found to have bladder cancer during the screening study but were not referred for evaluation based on their hematuria. The source of hematuria was unknown in 65%, infection in 22%, benign prostatic enlargement in 10%, and renal stone disease in 4%, but these results are based on incomplete evaluation since only 12.8% underwent cystoscopy.
Subjects at high risk for bladder cancer based on > or = 10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria.
确定血尿高危患者是否按照指南建议进行评估。
我们最近对 1502 名高危人群（年龄>50 岁、吸烟史>10 年、或暴露于环境中 15 年以上）进行了一项基于尿液肿瘤标志物的膀胱癌筛查研究。我们评估了筛查研究前 3 年内的尿分析（UA）使用情况。进行病历回顾以确定这组有镜下血尿的患者是否接受了任何额外的评估。
在 1502 名研究参与者中，73.2%进行了常规尿分析，164 名（14.9%）受试者在纳入前有记录的血尿（>3 个红细胞/高倍视野）。其中，42.1%没有进一步评估。额外的检测包括重复尿分析（36%）、尿液培养（15.2%）、细胞学检查（10.4%）、影像学检查（22.6%，包括 15.9%的 CT、4.3%的静脉肾盂造影；2.4%的 MRI）和膀胱镜检查（12.8%）。在筛查研究中，3 名镜下血尿（2%）患者随后被发现患有膀胱癌，但由于血尿未被转诊进行评估。65%的血尿来源不明，22%的血尿由感染引起，10%的血尿由良性前列腺增生引起，4%的血尿由肾结石引起，但这些结果是基于不完全评估得出的，因为只有 12.8%的患者接受了膀胱镜检查。
基于>10 年吸烟或环境暴露且有镜下血尿的膀胱癌高危患者很少进行全面评估，只有 12.8%的患者被转诊接受泌尿科评估。需要进一步研究评估血尿指南的利用和有效性。
