Sultana S R, Goodman C M, Byrne D J, Baxby K
Department of Urology, Dundee Royal Infirmary, UK.
Br J Urol. 1996 Nov;78(5):691-6; discussion 697-8. doi: 10.1046/j.1464-410x.1996.01975.x.
To determine which patients with asymptomatic microscopic haematuria (AMH) should be investigated to exclude significant urological pathology.
The study comprised a prospective audit of a standard protocol for investigating all patients referred with haematuria over one year in a haematuria clinic in the urology department serving Tayside, Scotland. Investigations included urine culture and cytology, flexible cystoscopy, and upper tract imaging which consisted of both excretory urography and renal ultrasonography in many of the patients.
A total of 381 patients with microscopic haematuria was investigated. No malignancy was found in any < 50 years of age (n = 131); in patients aged > 50 years the overall incidence of malignancy was 7.5% (19/250). The asymptomatic patients in this group had a lower incidence (5%, 6/126) of malignancy than the symptomatic patients (10.5%, 13/124) but this difference did not reach statistical significance. There was no statistically significant difference in the incidence of urological malignancy between men and in women with microscopic haematuria. During the same period, 233 patients were referred with frank haematuria; in these patients, those aged < 50 years had a 10% incidence of malignancy (6/60), while in those aged > 50 years the incidence was 34.5% (60/173). A total of 18 patients (4.7%) with microscopic haematuria had upper tract calculi, comprising 5.3% (7/131) of patients aged < 50 years and 4.4% (11/250) of those > 50 years with microscopic haematuria.
The investigation of older patients with microscopic haematuria (and all those with frank haematuria) is well justified, as malignancy will be found in a significant proportion even if they are asymptomatic. The benefit of a full urological investigation of younger patients with microscopic haematuria is debatable.
确定哪些无症状镜下血尿（AMH）患者需要进行检查以排除重大泌尿系统病变。
本研究包括对苏格兰泰赛德地区泌尿外科血尿诊所一年内转诊的所有血尿患者进行标准检查方案的前瞻性审核。检查包括尿培养和细胞学检查、软性膀胱镜检查，以及上尿路成像，许多患者的上尿路成像包括排泄性尿路造影和肾脏超声检查。
共对381例镜下血尿患者进行了检查。50岁以下患者（n = 131）均未发现恶性肿瘤；50岁以上患者的恶性肿瘤总发生率为7.5%（19/250）。该组无症状患者的恶性肿瘤发生率（5%，6/126）低于有症状患者（10.5%，13/124），但这种差异无统计学意义。镜下血尿男性和女性的泌尿系统恶性肿瘤发生率无统计学显著差异。同期，233例肉眼血尿患者前来就诊；在这些患者中，50岁以下患者的恶性肿瘤发生率为10%（6/60），而50岁以上患者的发生率为34.5%（60/173）。共有18例（4.7%）镜下血尿患者患有上尿路结石，其中50岁以下患者占5.3%（7/131），50岁以上镜下血尿患者占4.4%（11/250）。
对老年镜下血尿患者（以及所有肉眼血尿患者）进行检查是合理的，因为即使他们无症状，也会有相当比例的患者被发现患有恶性肿瘤。对年轻镜下血尿患者进行全面泌尿系统检查的益处存在争议。
