Bradley Megan S, Willis-Gray Marcella G, Amundsen Cindy L, Siddiqui Nazema Y
Divisions of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
J Urol. 2016 Apr;195(4 Pt 1):937-41. doi: 10.1016/j.juro.2015.10.136. Epub 2015 Oct 30.
In 2012 the AUA (American Urological Association) released a revision of the asymptomatic microscopic hematuria guidelines. Our study objectives were to assess adherence to these guidelines and describe the prevalence of urinary tract malignancy in postmenopausal women at our institution.
This is a cross-sectional analysis of women older than 55 years evaluated at the Division of Urogynecology or Urology from August 2012 to August 2014 for a diagnosis of asymptomatic microscopic hematuria. Women who underwent evaluation for 3 or more red blood cells per high power field on microscopic urinalysis were considered to have true asymptomatic microscopic hematuria. Those evaluated after a dipstick test with blood who had fewer than 3 red blood cells per high power field on urinalysis or no urinalysis were considered positive dipstick. Demographics, laboratory values, imaging results and cystoscopy findings were extracted from electronic medical records.
Our study population included 237 women with a mean ± SD age of 67.1 ± 8.3 years. In our overall population 169 of 237 women (71.3%) had true asymptomatic microscopic hematuria, 48 (20.3%) had a positive dipstick test and 20 (8.4%) underwent evaluation in the setting of urinary tract infection. We detected 3 urinary tract malignancies (1.4%). One kidney cancer was identified in a 56-year-old current smoker with a urine dipstick result of 1+ blood. Bladder cancer was detected in a 58-year old smoker with 6 red blood cells per high power field on urinalysis and in a 64-year-old nonsmoker with 42 red blood cells per high power field on urinalysis.
In postmenopausal women evaluated for asymptomatic microscopic hematuria the overall prevalence of urinary tract malignancy was low at 1.4%. Of our population 28.7% underwent evaluation without meeting guideline criteria for asymptomatic microscopic hematuria. This demonstrates an opportunity to improve adherence to existing guidelines to provide high quality care and avoid unnecessary expensive testing.
2012年美国泌尿外科学会（AUA）发布了无症状镜下血尿指南的修订版。我们的研究目的是评估对这些指南的遵循情况，并描述我院绝经后女性尿路恶性肿瘤的患病率。
这是一项横断面分析，研究对象为2012年8月至2014年8月在我院妇科泌尿或泌尿外科接受评估以诊断无症状镜下血尿的55岁以上女性。镜检尿沉渣每高倍视野有3个或更多红细胞的女性被视为真正的无症状镜下血尿。那些在尿试纸检测出血液阳性后接受评估，但镜检尿沉渣每高倍视野红细胞少于3个或未进行尿沉渣检查的女性被视为尿试纸阳性。从电子病历中提取人口统计学、实验室检查值、影像学结果和膀胱镜检查结果。
我们的研究人群包括237名女性，平均年龄±标准差为67.1±8.3岁。在我们的总体人群中，237名女性中有169名（71.3%）有真正的无症状镜下血尿，48名（20.3%）尿试纸检测阳性，20名（8.4%）在尿路感染情况下接受评估。我们检测到3例尿路恶性肿瘤（1.4%）。1例肾癌在一名56岁的现吸烟者中被发现，尿试纸检测结果为1+血尿。膀胱癌在一名58岁的吸烟者中被检测到，镜检尿沉渣每高倍视野有6个红细胞，在一名64岁的非吸烟者中被检测到，镜检尿沉渣每高倍视野有42个红细胞。
在接受无症状镜下血尿评估的绝经后女性中，尿路恶性肿瘤的总体患病率较低，为1.4%。在我们的人群中，28.7%的人在不符合无症状镜下血尿指南标准的情况下接受了评估。这表明有机会提高对现有指南的遵循程度，以提供高质量的医疗服务并避免不必要的昂贵检查。
