Vanderbilt University Medical Center, Nashville, Tennessee.
Mayo Clinic.
J Urol. 2020 Oct;204(4):778-786. doi: 10.1097/JU.0000000000001297. Epub 2020 Jul 23.
Patients presenting with microhematuria represent a heterogeneous population with a broad spectrum of risk for genitourinary malignancy. Recognizing that patient-specific characteristics modify the risk of underlying malignant etiologies, this guideline sought to provide a personalized diagnostic testing strategy.
The systematic review incorporated evidence published from January 2010 through February 2019, with an updated literature search to include studies published up to December 2019. Evidence-based statements were developed by the expert Panel, with statement type linked to evidence strength, level of certainty, and the Panel's judgment regarding the balance between benefits and risks/burdens.
Microhematuria should be defined as ≥ 3 red blood cells per high power field on microscopic evaluation of a single specimen. In patients diagnosed with gynecologic or non-malignant genitourinary sources of microhematuria, clinicians should repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause. The Panel created a risk classification system for patients with microhematuria, stratified as low-, intermediate-, or high-risk for genitourinary malignancy. Risk groups were based on factors including age, sex, smoking and other urothelial cancer risk factors, degree and persistence of microhematuria, as well as prior gross hematuria. Diagnostic evaluation with cystoscopy and upper tract imaging was recommended according to patient risk and involving shared decision-making. Statements also inform follow-up after a negative microhematuria evaluation.
Patients with microhematuria should be classified based on their risk of genitourinary malignancy and evaluated with a risk-based strategy. Future high-quality studies are required to improve the care of these patients.
出现镜下血尿的患者代表了一个异质性人群，他们存在广泛的泌尿生殖系统恶性肿瘤风险。鉴于患者的具体特征会改变潜在恶性病因的风险，本指南旨在提供个性化的诊断检测策略。
系统综述纳入了 2010 年 1 月至 2019 年 2 月发表的证据，并进行了更新的文献检索，纳入了截至 2019 年 12 月发表的研究。专家组制定了基于证据的声明，声明类型与证据强度、确定性水平以及专家组对获益与风险/负担之间平衡的判断相关联。
镜下血尿应定义为单次标本显微镜检查时每高倍镜视野下≥3 个红细胞。在诊断为妇科或非恶性泌尿生殖系统来源镜下血尿的患者中，在妇科或非恶性泌尿生殖系统病因得到解决后，临床医生应重复进行尿液分析。专家组为镜下血尿患者创建了一个泌尿生殖系统恶性肿瘤风险分类系统，分为低、中、高风险组。风险组基于年龄、性别、吸烟和其他尿路上皮癌危险因素、血尿程度和持续时间以及既往肉眼血尿等因素进行分层。根据患者的风险和涉及共同决策，推荐采用基于风险的策略进行膀胱镜检查和上尿路成像检查。声明还告知了镜下血尿阴性评估后的随访。
应根据患者泌尿生殖系统恶性肿瘤的风险对出现镜下血尿的患者进行分类，并采用基于风险的策略进行评估。需要未来进行高质量的研究来改善这些患者的治疗。
