Månsson A, Anderson H, Colleen S
Department of Urology, University Hospital, Lund, Sweden.
Scand J Urol Nephrol. 1993;27(3):363-9. doi: 10.3109/00365599309180448.
Delay in diagnosis of carcinoma of the urinary bladder was studied in 343 patients. The median patient's delay (time from first symptom to first consultation) was 15 days, and was longer when the only presenting symptom was urgency of micturition than when it was haematuria (45 vs. 5 days, p < 0.001). In advanced (T2-T4) tumour, patient's delay was 21 days and in Ta-T1 it was 13 days (NS). The median doctor's delay (time from first consultation to diagnosis) was 62 days. It comprised two phases: A from consultation to first referral and B from first referral to diagnosis-respective medians 6 and 47 days. Median doctor's delay (A+B) was longer when the initial consultation was with a general practitioner than with a urologist (78 vs. 21 days, p < 0.001) and longer in patients older than 70 years (69 vs. 54 days, p < 0.01). Doctor's delay correlated with symptoms, being longest in cases with only urgency and shortest in haematuria plus pain (114 vs. 44 days, p < 0.001), and also with number of referrals (33, 63, 230 and 117 days, respectively, for 0, 1, 2 and 3 referrals). More women than men were referred a second or third time (25.6% vs. 8.6%, p < 0.001), and doctor's delay was longer for women (76 vs. 59 days, p < 0.05). A questionnaire completed by 203 of the 229 surviving patients revealed no significant correlation between psychosocioeconomic factors and patient's delay.
对343例膀胱癌患者的诊断延迟情况进行了研究。患者的中位延迟时间（从出现首个症状到首次就诊的时间）为15天，当唯一的首发症状为尿频时，患者的延迟时间比出现血尿时更长（45天对5天，p<0.001）。在晚期（T2 - T4）肿瘤患者中，患者的延迟时间为21天，Ta - T1期患者为13天（无显著差异）。医生的中位延迟时间（从首次就诊到确诊的时间）为62天。这包括两个阶段：A阶段从就诊到首次转诊，B阶段从首次转诊到确诊，各自的中位时间分别为6天和47天。当首次就诊是看全科医生时，医生的中位延迟时间（A + B）比看泌尿科医生时更长（78天对21天，p<0.001），70岁以上患者的医生延迟时间也更长（69天对54天，p<0.01）。医生的延迟与症状有关，仅表现为尿频的病例延迟时间最长，血尿伴疼痛的病例延迟时间最短（114天对44天，p<0.001），并且也与转诊次数有关（0次、1次、2次和3次转诊的患者分别为33天、63天、230天和117天）。女性比男性被二次或三次转诊的比例更高（25.6%对8.6%，p<0.001），女性的医生延迟时间也更长（76天对59天，p<0.05）。229例存活患者中有203例完成的一份问卷显示，社会心理经济因素与患者延迟之间无显著相关性。
