Malmström Per-Uno, Skaaheim Haug Erik, Boström Peter J, Gudjónsson Sigidur, Bjerggaard Jensen Jørgen
a Department of Urology, Division of Surgical Sciences , Uppsala University , Uppsala , Sweden.
b Department of Urology , Vestfold Hospital Trust , Tønsberg , Norway.
Scand J Urol. 2019 Feb;53(1):1-6. doi: 10.1080/21681805.2018.1555187. Epub 2019 Jan 14.
To describe the management of patients with hematuria in the Nordic countries in relation to bladder cancer epidemiology, especially in the context of introducing fast track pathways with the aim of proposing a common guideline. Epidemiological data on bladder cancer from each country, and the combined cancer registry, Nordcan, were analyzed. The evolution of the different national recommendations and the introduction of fast track pathways were assessed. Patients' demographics, type of hematuria and cancer detection rates were analysed if available. The crude incidence of bladder cancer has increased substantially since the 1960s, while the age standardized incidence has been stable during recent decades. The relative survival has increased in all countries, while the mortality has been stable. For those with microscopic hematuria there has been a clear trend towards less rigorous investigations. In the fast track pathways, introduced in three of five countries, about one in five patients with macroscopic hematuria had a cancer diagnosis. Data show that time to diagnosis has been reduced. The number of patients with bladder cancer is increasing in the Nordic region. The introduction of fast track pathways has been important in improving the management of patients with suspicion of the disease. Our recommendation is to focus on macroscopic hematuria in the fast track pathways. Microhematuria without any symptoms should not be an indication for cystoscopy. However, urinary tract symptoms accompanied by microhematuria can still be investigated according to respective guidelines but not necessarily within fast track pathways.
为描述北欧国家血尿患者的管理情况与膀胱癌流行病学的关系，特别是在引入快速通道流程以制定通用指南的背景下。分析了每个国家以及合并的癌症登记处Nordcan的膀胱癌流行病学数据。评估了不同国家建议的演变以及快速通道流程的引入情况。如有可用数据，还分析了患者的人口统计学特征、血尿类型和癌症检出率。自20世纪60年代以来，膀胱癌的粗发病率大幅上升，而近几十年来年龄标准化发病率一直稳定。所有国家的相对生存率都有所提高，而死亡率一直稳定。对于镜下血尿患者，调查趋于不再那么严格。在五个国家中的三个引入的快速通道流程中，约五分之一的肉眼血尿患者被诊断患有癌症。数据显示诊断时间有所缩短。北欧地区膀胱癌患者数量正在增加。快速通道流程的引入对于改善疑似该病患者的管理非常重要。我们的建议是在快速通道流程中关注肉眼血尿。无症状的镜下血尿不应作为膀胱镜检查的指征。然而，伴有镜下血尿的尿路症状仍可根据各自的指南进行检查，但不一定在快速通道流程内。
