Dana A, Michel J R, Sterin P, Affre J, Moreau J F
J Radiol. 1980 Oct;61(10):585-90.
A prospective study was conducted in 1,878 patients found to have hematuria, among 11,000 new cases attending for consultation over a period of 27 months, who were then followed-up for several months to several years. The results confirmed some well-established facts but several unusual features were observed. Intravenous urography, when technically complete, detected urinary tract lesions in 60 p. cent of cases. Complementary examinations (cystoscopy, angiography, renal biopsy), which should not all be conducted systematically, but only as a function of the results of the IVU, the type of hematuria, and clinical and biological findings, considerably increase the percentage of positive results. The etiology remained obscure in less than 10 p. cent of cases but not all of these patients had benefited from a full range of complementary examinations, that should have been conducted. Associated anticoagulant treatment and the microscopic nature of the hematuria should never lead to delay in IVU examination, and a reassuring diagnosis of a benign lesion. The authors emphasize the high frequency of associated lesions. For this reason, a complete IVU should be conducted whatever the initial findings. Furthermore, the reassuring diagnosis of an atypical benign cause for the hematuria (renal cyst, prostatic adenoma, etc.) should not be too easily accepted before exploring the possibility of a second lesion, truly responsible for the hematuria and having an entirely different prognosis.
对11000例在27个月内前来就诊的新病例中发现的1878例血尿患者进行了一项前瞻性研究，随后对这些患者进行了数月至数年的随访。结果证实了一些已确立的事实，但也观察到了一些不寻常的特征。静脉尿路造影在技术操作完整时，能在60%的病例中检测到尿路病变。补充检查（膀胱镜检查、血管造影、肾活检）不应全部系统地进行，而应仅根据静脉尿路造影的结果、血尿的类型以及临床和生物学检查结果来进行，这可显著提高阳性结果的百分比。在不到10%的病例中病因仍不清楚，但并非所有这些患者都接受了本应进行的全面补充检查。联合抗凝治疗和血尿的微观性质绝不应该导致静脉尿路造影检查的延迟以及对良性病变的放心诊断。作者强调了合并病变的高发生率。因此，无论最初的检查结果如何，都应进行完整的静脉尿路造影。此外，在探寻真正导致血尿且预后完全不同的第二种病变的可能性之前，不应轻易接受血尿的非典型良性病因（肾囊肿、前列腺腺瘤等）的放心诊断。
