Rotkopf L, Hélénon O, Chrétien Y, Souissi M, Melki P, Moreau J F
Service de Radiologie, Hôpital Necker, Paris.
J Urol (Paris). 1993;99(4):192-209.
Hematuria is defined as the presence of blood in urine. Its site of origin can be in any point of the urinary tract. Its discovery leads to clinical, biological and radiological investigations. The causes of hematuria are dominated, in terms of frequency, by urinary infection and lithiasis. The risk of associated lesions, especially of a tumor, must lead to regarding them as excluding diagnoses. Besides the so-called "medical" hematurias of glomerular origin (hematuria with proteinuria and cylinder casts) and hematurias occurring during a first episode of cystitis in women, the radiological exploration of "surgical" hematuria is systematic and always begins with an IVP. When the IVP is normal, a cystoscopy is most often made. The other radiological examinations (CT, Doppler ultrasound) are performed only according to the findings of IVP and cystoscopy. Arteriography combined with renal phlebography is indicated if the assessment is negative in case of recurrent hematuria or of massive hematuria. It is mainly aimed at detecting a vascular malformation. When this exploration is completed, an etiology is found is about 90% of all cases.
血尿定义为尿液中存在血液。其起源部位可在尿路的任何一点。血尿的发现会引发临床、生物学和放射学检查。就发生频率而言，血尿的病因以泌尿系统感染和结石为主。相关病变尤其是肿瘤的风险，必须将其视为排除性诊断。除了所谓源于肾小球的“内科性”血尿（伴有蛋白尿和管型的血尿）以及女性膀胱炎首次发作时出现的血尿外，对“外科性”血尿的放射学检查是系统性的，且总是从静脉肾盂造影（IVP）开始。当IVP正常时，最常进行膀胱镜检查。其他放射学检查（CT、多普勒超声）仅根据IVP和膀胱镜检查的结果进行。如果对复发性血尿或大量血尿的评估结果为阴性，则需进行动脉造影联合肾静脉造影。其主要目的是检测血管畸形。当这项检查完成后，约90%的病例能找到病因。
