Rehber, asemptomatik mikrohematürinin tedavisini standardize etmeyi amaçlıyor.

Guideline Aims to Standardize Treatment of Asymptomatic Microhematuria

Nov 13, 2012

By David Douglas

NEW YORK (Reuters Health) Nov 13 – The American Urological Association (AUA) has issued an updated guideline for managing asymptomatic microhematuria (AMH), which it hopes will even out the care patients receive.

Dr. Stuart Wolf, Jr., who chairs the AUA Practice Guidelines Committee, told Reuters Health by email that the new guideline on asymptomatic microscopic hematuria “should lead to a desirable standardization of the evaluation of patients with this common problem. By reducing variation in practice, the AUA hopes to improve the overall quality of health care.”

The document, online now in the Journal of Urology, was developed based on findings from 192 articles as well as expert opinion. It addresses diagnosis, evaluation, and follow-up of AMH, with 19 statements.

The authors of the guideline stress that AMH is only “diagnosed by microscopy; a dipstick reading suggestive of hematuria should not lead to imaging or further investigation without confirmation of three or greater red blood cells per high power field.”

Moreover, the authors say, “AMH is a sign, not a diagnosis or health condition.”

Assessment “should include a careful history, physical examination and laboratory examination to rule out benign causes.”

Should these be ruled out, patients 35 years or older should undergo cystoscopy; upper urinary tract imaging is indicated in all adults. However, “the risks and burdens of using blue light cystoscopy in the initial evaluation of patients… outweigh the benefits.”

Moreover, doctors should account for “variations in resources, and patient tolerances, needs, and preferences.”

And unfortunately, as the writers warn, “Conformance with any clinical guideline does not guarantee a successful outcome.”

In particular, the panel of experts observes, “Patients with causes of AMH that persist and may not require intervention, such as those with enlarged prostate… present a special challenge since malignant causes of AMH may be masked by the presence of these other entities.”

These patients, they conclude, should “undergo annual urinalysis” and clinicians should “use judgment and knowledge of risk factors to decide when and whether to perform a re-evaluation.”

As is the case with other guidelines, the committee that wrote this one points out that it couldn’t evaluate “all data on emerging technologies or management, including those that are FDA-approved, which may immediately come to represent accepted clinical practices.” But simply because such approaches may be too new to be addressed by the guidelines, it does not necessarily follow that they are experimental or investigational, the authors say.

A PDF copy of the complete guideline is available at http://bit.ly/RAZS5r.

SOURCE: http://bit.ly/SKsNmt

J Urol 2012.