Yafi Faysal A, Aprikian Armen G, Tanguay Simon, Kassouf Wassim
Department of Surgery (Urology), McGill University, Montreal, QC.
Can Urol Assoc J. 2011 Apr;5(2):97-101. doi: 10.5489/cuaj.10059.
Hematuria is one of the most common findings on urinalysis in patients encountered by primary care physicians. In many instances it can also be the first presentation of a serious urological problem. As such, we sought to evaluate current practices adopted by primary care physicians in the workup and screening of hematuria.
Questionnaires were mailed to all registered primary care physicians across Quebec. Questions covered each physician's personal approach to men and postmenopausal women with painless gross hematuria or with asymptomatic microscopic hematuria, as well as screening techniques, general knowledge with regards to urine collection and sampling, and referral patterns.
Of the surveys mailed, 599 were returned. Annual routine screening urinalysis on all adult male and female patients was performed by 47% of respondents, regardless of age or risk factors. Of all the respondents, 95% stated microscopic hematuria was associated with bladder cancer. However, in an older male with painless gross hematuria, only 64% of respondents recommended further evaluation by urology. On the other hand, in a postmenopausal woman with 2 consecutive events of significant microscopic hematuria, only 48.6% recommended referral to urology. Findings were not associated with the gender of the respondent, experience or geographic location of practice (urban vs. rural).
There seems to be reluctance amongst primary care physicians to refer patients with gross or significant microscopic hematuria to urology for further investigation. A higher level of suspicion and further education should be implemented to detect serious conditions and to offer earlier intervention when possible.
血尿是初级保健医生诊治的患者尿液分析中最常见的发现之一。在许多情况下，它也可能是严重泌尿系统问题的首发症状。因此，我们试图评估初级保健医生在血尿检查和筛查中采用的现行做法。
向魁北克省所有注册的初级保健医生邮寄问卷。问题涵盖了每位医生对无痛肉眼血尿或无症状镜下血尿的男性和绝经后女性的个人处理方法，以及筛查技术、尿液收集和采样的一般知识，和转诊模式。
在邮寄的调查问卷中，有599份被退回。47%的受访者对所有成年男性和女性患者进行年度常规尿液分析筛查，无论其年龄或风险因素如何。在所有受访者中，95%表示镜下血尿与膀胱癌有关。然而，对于一名有无痛肉眼血尿的老年男性，只有64%的受访者建议泌尿外科进一步评估。另一方面，对于一名绝经后女性，连续两次出现明显镜下血尿，只有48.6%的受访者建议转诊至泌尿外科。研究结果与受访者的性别、经验或执业地理位置（城市与农村）无关。
初级保健医生似乎不愿意将肉眼血尿或明显镜下血尿患者转诊至泌尿外科进行进一步检查。应提高怀疑程度并加强进一步教育，以发现严重疾病并尽可能提供早期干预。
