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#1
06.03.2021, 16:19
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УЗИ почек и мочевого. Есть ли показания к МРТ или цистоскопию?
Мужчина.
35 лет, не пью и не курю вес - 84 рост - 175 В настоящее время ничего не беспокоит Пару лет назад проходил лечение бактериального простатита(отдельная тема есть на форуме). По УЗИ простаты - норма. Более 5 лет в анализах есть микрогематурия из-за этого год назад делал МРТ с контрастом(мочевой) и КТ с контрастом(почки) По обоим исследованиям - все в норме и без патологий Так же врач сказал делать каждый месяц узи мочевого, я его выполняю уже год, последний раз делал 2 месяца назад [Ссылки доступны только зарегистрированным пользователям ] Я хотел бы утонить на форуме врачей, если я не наблюдаю мочу в крови и меня ничего не беспокоит, то стоит ли мне делать цистоскопию? Или можно продолжать контролировать по УЗИ и как часто? Можно ли делать узи хотя бы раз в 2 месяца? 
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#2
06.03.2021, 19:24
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#3
06.03.2021, 20:02
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#4
06.03.2021, 21:33
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Читайте ,если не владеете английским,транслит в помощь.
Рекомендации Американской урологической Ассоциации. American Urological Association Diagnosis, Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults (2016) Guideline Statements 1. Asymptomatic microhematuria (AMH) is defined as three or greater red blood cells (RBC) per high powered field (HPF) on a properly collected urinary specimen in the absence of an obvious benign cause. A positive dipstick does not define AMH, and evaluation should be based solely on findings from microscopic examination of urinary sediment and not on a dipstick reading. A positive dipstick reading merits microscopic examination to confirm or refute the diagnosis of AMH. Expert Opinion 2. The assessment of the asymptomatic microhematuria patient should include a careful history, physical examination, and laboratory examination to rule out benign causes of AMH such as infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or recent urological procedures. Clinical Principle 3. Once benign causes have been ruled out, the presence of asymptomatic microhematuria should prompt a urologic evaluation. Recommendation (Evidence Strength Grade C) 4. At the initial evaluation, an estimate of renal function should be obtained (may include calculated eGRF, creatinine, and BUN) because intrinsic renal disease may have implications for renal related risk during the evaluation and management of patients with AMH. Clinical Principle 5. The presence of dysmorphic red blood cells, proteinuria, cellular casts, and/or renal insufficiency, or any other clinical indicator suspicious for renal parenchymal disease warrants concurrent nephrologic workup but does not preclude the need for urologic evaluation. Recommendation (Evidence Strength Grade C) 6. Microhematuria that occurs in patients who are taking anti-coagulants requires urologic evaluation and nephrologic evaluation regardless of the type or level of anti-coagulation therapy. Recommendation (Evidence Strength Grade C) 7. For the urologic evaluation of asymptomatic microhematuria, a cystoscopy should be performed on all patients aged 35 years and older. Recommendation (Evidence Strength Grade C) 8. In patients younger than age 35 years, cystoscopy may be performed at the physician's discretion. Option (Evidence Strength Grade C) 9. A cystoscopy should be performed on all patients who present with risk factors for urinary tract malignancies (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures) regardless of age. Clinical Principle 10. The initial evaluation for AMH should include a radiologic evaluation. Multi-phasic computed tomography (CT) urography (without and with intravenous (IV) contrast), including sufficient phases to evaluate the renal parenchyma to rule out a renal mass and an excretory phase to evaluate the urothelium of the upper tracts, is the imaging procedure of choice because it has the highest sensitivity and specificity for imaging the upper tracts. Recommendation (Evidence Strength Grade C) 11. For patients with relative or absolute contraindications that preclude use of multi-phasic CT (such as renal insufficiency, contrast allergy, pregnancy), magnetic resonance urography (MRU) (without/with IV contrast) is an acceptable alternative imaging approach. Option (Evidence Strength Grade C) 12. For patients with relative or absolute contraindications that preclude use of multiphase CT (such as renal insufficiency, contrast allergy, pregnancy) where collecting system detail is deemed imperative, combining magnetic resonance imaging (MRI) with retrograde pyelograms (RPGs) provides alternative evaluation of the entire upper tracts. Expert Opinion 13. For patients with relative or absolute contraindications that preclude use of multiphase CT (such as renal insufficiency, contrast allergy) and MRI (presence of metal in the body) where collecting system detail is deemed imperative, combining non-contrast CT or renal ultrasound (US) with retrograde pyelograms (RPGs) provides alternative evaluation of the entire upper tracts. Expert Opinion 14. The use of urine cytology and urine markers (NMP22, BTA-stat, and UroVysion FISH) is NOT recommended as a part of the routine evaluation of the asymptomatic microhematuria patient. Recommendation (Evidence Strength Grade C) 15. In patients with persistent microhematuria following a negative work up or those with other risk factors for carcinoma in situ (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures), cytology may be useful. Option (Evidence Strength Grade C) 16. Blue light cystoscopy should not be used in the evaluation of patients with asymptomatic microhematuria. Recommendation (Evidence Strength Grade C) 17. If a patient with a history of persistent asymptomatic microhematuria has two consecutive negative annual urinalyses (one per year for two years from the time of initial evaluation or beyond), then no further urinalyses for the purpose of evaluation of AMH are necessary. Expert Opinion 18. For persistent asymptomatic microhematuria after negative urologic work up, yearly urinalyses should be conducted. Recommendation (Evidence Strength Grade C) 19. For persistent or recurrent asymptomatic microhematuria after initial negative urologic work-up, repeat evaluation within three to five years should be considered. Expert Opinion Согласно п.16-цистоскопия НЕ показана. Согласно п.18-при отрицательном урологическом обследовании,и сохраняющейся микрогематурии/эритроцитурии/,анализ мочи 1раз В ГОД!! Об узи вообще речь не идет.
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#5
06.03.2021, 21:55
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Спасибо, доктор
Изучил Креатинин и мочевина у меня в норме, так же сдавал месяц назад Остался один вопрос, точнее уточнение В пунке7 написано, что с 35 лет нужно выполнять цистоскопию Цитата:
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Линейный вид
