肉眼血尿的评估

Visible (gross) haematuria is urine that is visibly discoloured by blood or blood clot. It may present as urine that is red to brown, or as frank blood. As little as 1 mL of blood can impart colour to 1 litre of urine.

即使肉眼血尿是一过性或无症状的，也可能提示某种严重疾病，一定需要进一步检查。病因范畴与年龄具有明显相关性，儿童、35 岁以下成人以及 35 岁以上成人的血尿处理存在差异。

Patients with visible haematuria represent a higher-risk group for urological malignancy than those presenting with non-visible haematuria.[1]Nielsen M, Qaseem A. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016 Apr 5;164(7):488-97.https://annals.org/aim/fullarticle/2484287/hematuria-marker-occult-urinary-tract-cancer-advice-high-value-carehttp://www.ncbi.nlm.nih.gov/pubmed/26810935?tool=bestpractice.com[2]Kaag MG, Raman JD. Clinical guidelines: Clearing murky water - a guideline-based approach to haematuria. Nat Rev Urol. 2016 Apr 13;13(5):243-4.http://www.ncbi.nlm.nih.gov/pubmed/27071454?tool=bestpractice.com[3]Loo RK, Lieberman SF, Slezak JM, et al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc. 2013 Jan 9;88(2):129-38.http://www.ncbi.nlm.nih.gov/pubmed/23312369?tool=bestpractice.com 肉眼血尿是 66% 以上尿路上皮癌患者的首发体征。[4]Edwards TJ, Dickinson AJ, Natale S, et al. A prospective analysis of the diagnostic yield resulting from 4020 patients at a protocol-driven haematuria clinic. BJU Int. 2006 Feb;97(2):301-5.http://www.ncbi.nlm.nih.gov/pubmed/16430634?tool=bestpractice.com 肉眼血尿提示恶性肿瘤的敏感性高：对识别膀胱上皮癌的敏感性为 0.83，对识别输尿管癌的敏感性为 0.66，对识别肾细胞癌的敏感性为 0.48。[5]Buntinx F, Wauters H. The diagnostic value of macroscopic haematuria in diagnosing urological cancers: a meta-analysis. Fam Pract. 1997 Feb;14(1):63-8.https://academic.oup.com/fampra/article/14/1/63/548718http://www.ncbi.nlm.nih.gov/pubmed/9061347?tool=bestpractice.com However, the oncological significance of visible haematuria is different for males and females. In men aged >60 years, the positive predictive value of visible haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%.[6]Hicks D, Li CY. Management of macroscopic haematuria in the emergency department. Emerg Med J. 2007 Jun;24(6):385-90.http://www.ncbi.nlm.nih.gov/pubmed/17513531?tool=bestpractice.com

尿路上皮癌的危险因素包括：

• 男性

• 35 岁或以上

• 吸烟

• 接触苯、芳香胺、致癌物、化疗或高剂量镇痛药

• 存在以下病史：

  • 排尿刺激症状

  • 慢性尿路感染

  • 留置导尿管

  • 盆腔放射治疗。