Korean Journal of Nephrology 1999;18(1):128-133.
혈뇨 환자에서 방광경 검사의 유용성 (Cystoscopy in the Evaluation of Hematuria)
신규태, 이한민, 김승정, 마경애, 지석배, 김상돈, 김홍수, 김도헌, 안현수, 정도영, 김영수 (Gyu Tae Shin, Han Min Lee, Seung Jung Kim, Kyoung Ai Ma, Seog Bae Ji, Sang Don Kim, Heung Soo Kim, Do Hun Kim, Hyun Soo Ahn, Do Young Chung and Young Soo Kim)
Abstract
Hematuria is a common presentation of bladder cancer. As medical examinations for health screening are becoming more popular, increasing number of patients are found to have hematuria. When to refer these patients to urologists for cystoscopy is a common problem to nephrologists and a matter of debate as well. In fact, many authors differ in their opinions on this issue, especially in cases of microscopic hematuria. Given the fact that the incidence of bladder cancer varies between countries, it will be reasonable that the investigation strategy for Koreans should be determined according to the studies on Korean people. In the present study, we retrospectively analyzed 349 patients who underwent cystoscopic examinations in our institution to investigate causes of microscopic or gross hematuria. Bladder cancer was detected on cystoscopy in 35(15.9%) of 220 patients with gross hematuria, in contrast to patients with microscopic hematuria in whom 2(1.6%) of 129 patients were found to have bladder cancer. Eighty nine percents of cancer patients were male. Bladder cancer was detected even in relatively young patients with gross hematuria, while no bladder cancer was found in patients with microscopic hematuria below 60 years of age. Urine cytology was revealing in 59.5% of cancer patients. Bladder cancer was detected in 71.4% and 76.2% of cancer cases by sonography and IVP, respectively. Urine protein by dipstick was unreliable in predicting the presence of cancer. In conclusion, decision on cystoscopy in patients with asymptomatic microscopic hematuria younger than 50-60 years of age should be made conservatively, while more aggressive diagnostic work up is necessary in patients with gross hematuria regardless of their age.
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