Rockall A G, Wetton C W, Thomas K E, Kellett M J
Department of Radiology, St. Mary's Hospital, London, UK.
Clin Radiol. 1996 Apr;51(4):282-4. doi: 10.1016/s0009-9260(96)80347-3.
There is considerable debate concerning the investigation of patients with asymptomatic microscopic haematuria. Urine dipstick testing is a sensitive screening test but may be positive in some normal individuals. The present consensus is that urine microscopy should be performed to confirm haematuria prior to further investigation. We have performed a retrospective study to establish whether urine microscopy was used in addition to dipstick testing before a request for intravenous urography (IVU) in three centres. IVU request forms from a District General, a Teaching Hospital and a Uroradiological Referral Centre were audited over a 9-month-period. Patients referred with asymptomatic microscopic haematuria were selected. The case notes and urine microscopy results were reviewed. The date of microscopy and its result and the interval between the result and the IVU request were established. One hundred and two cases have been examined, 17 (16.7%) of which were under the age of 40. Only 37 in total had significant haematuria on microscopy and of these, 32 results (31.4% of all cases) were available before the IVU request. In eight patients there was no evidence that urine microscopy had been performed. Fourteen patients had a urinary tract infection. Our findings show that IVUs are often requested on the basis of dipstick testing alone. Only one third of patients had confirmed significant haematuria at the time of IVU request and in some patients infection had not yet been excluded. Although prompt investigation of microscopic haematuria is important, it is essential that the diagnosis is established by microscopy before an IVU is requested.
对于无症状性镜下血尿患者的检查存在诸多争议。尿试纸条检测是一种敏感的筛查试验，但在一些正常个体中也可能呈阳性。目前的共识是，在进行进一步检查之前，应进行尿镜检以确认血尿。我们进行了一项回顾性研究，以确定在三个中心，在申请静脉肾盂造影（IVU）之前，除了尿试纸条检测外是否还进行了尿镜检。对一家地区综合医院、一家教学医院和一家泌尿放射转诊中心在9个月期间的IVU申请表进行了审核。选取了因无症状性镜下血尿前来就诊的患者。查阅了病历和尿镜检结果。确定了镜检日期及其结果，以及结果与IVU申请之间的间隔时间。共检查了102例病例，其中17例（16.7%）年龄在40岁以下。镜检时仅有37例有明显血尿，其中32例结果（占所有病例的31.4%）在IVU申请之前就已获得。有8例患者没有证据表明进行了尿镜检。14例患者患有尿路感染。我们的研究结果表明，IVU检查常常仅基于尿试纸条检测就被申请。在申请IVU时，只有三分之一的患者被证实有明显血尿，而且在一些患者中感染尚未排除。虽然对镜下血尿进行及时检查很重要，但在申请IVU之前必须通过镜检确立诊断。
