01-027 · EVIDENCE B · SOURCE-SENSITIVE
Visible blood in urine — even if painless and gone by the next day — still warrants a check-up
尿里出现肉眼看得见的血，哪怕不疼、哪怕第二天就干净了，也要去查一次
A routine urine test costs just a few dozen yuan, while a urinary-system ultrasound runs around 100–200 yuan. If a doctor deems it necessary, a cystoscopy can be added at a cost of roughly 1,000 yuan.
Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day.
B
Move “Visible blood in urine — even if painless and gone by the next day — still warrants a check-up” to Future Me's calendar
The excuse
Future Me has a clearer calendar, more patience, and apparently the same responsibilities.
What feels good now
Today I keep a little money, a few minutes and avoid interrupting my default routine.
What the source says
The source summarizes the return this way: “Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day.” Evidence grade B. The original states the population, caveats, and sources; this is not a personal forecast.
Use the original facts and limits. For an urgent medical, safety, financial, or legal issue, contact a qualified local professional or service.
THE ENGLISH EDITION
Original recommendation and evidence
27. Visible blood in urine — even if painless and gone by the next day — still warrants a check-up
Cost: A routine urine test costs just a few dozen yuan, while a urinary-system ultrasound runs around 100–200 yuan. If a doctor deems it necessary, a cystoscopy can be added at a cost of roughly 1,000 yuan.
In plain terms: Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day.
Benefit: A UK study analyzed electronic medical records from primary-care clinics, comparing 4,915 patients diagnosed with bladder cancer against 21,718 controls. Among patients with visible blood in urine, the proportion ultimately found to have bladder cancer was 2.8% for those aged 60+, with a 95% confidence interval of 2.5–3.1. For ages 40–59, the figure was 1.2%, with a 95% CI of 0.6–2.3. This proportion is known as the positive predictive value. Blood visible only under a microscope also carries significance; the odds ratio is 20, with a 95% CI of 12–33. For those over 60, this figure is 1.6%, with a 95% CI of 1.2–2.1.
Evidence grade: B
Sources: Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. British Journal of General Practice, 64(626), e584-e589. <https://doi.org/10.3399/bjgp14X681409>
Notes: The absence of pain is a key clue. Blood in urine caused by kidney stones or infections usually comes with abdominal or flank pain, plus frequent, urgent, or painful urination. Cancer-related bleeding, however, often causes no discomfort at all and may disappear for a few days before returning — which is why many people overlook it. Taking anticoagulant medications is not a valid reason to skip testing. Blood in urine after intense exercise or during a woman’s menstrual period can be re-evaluated before deciding on further checks. The benefit is rated “low” because it reflects only detection rates, not any measurable reduction in mortality resulting from early diagnosis.
Read the complete Chinese source and notes
27. 尿里出现肉眼看得见的血，哪怕不疼、哪怕第二天就干净了，也要去查一次
成本: 尿常规几十元，泌尿系超声一两百元。医生认为需要的话，再加一个膀胱镜，千元上下。
说人话: 60 岁以上的人出现一次肉眼看得见的血尿，最后查出膀胱癌的概率约 2.8%，40 到 59 岁约 1.2%。这个数不算高，但也高到必须去查一次。哪怕第二天不出血了也要去查。
收益: 英国拿社区全科门诊（初级医疗）的电子病历做了一项研究，4915 例膀胱癌对 21718 例对照。出现肉眼血尿的人里，最后真查出膀胱癌的比例是这样。60 岁以上是 2.8%，可信范围 95% CI 2.5 到 3.1。40 到 59 岁是 1.2%，可信范围 0.6 到 2.3。这个比例的学名叫阳性预测值。只有在显微镜下才看得见的血尿，同样有意义。比值比 20，可信范围 95% CI 12 到 33。60 岁以上这个比例为 1.6%，可信范围 1.2 到 2.1
证据等级: B
来源: Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. British Journal of General Practice, 64(626), e584-e589. <https://doi.org/10.3399/bjgp14X681409>
备注: 「不疼」是关键。结石和感染引起的血尿，多半同时腰腹绞痛，或者尿频、尿急、尿痛。肿瘤引起的往往一点感觉都没有，而且会自己停几天再出现，很多人就这么放过了。正在吃抗凝药，不是可以不查的理由。剧烈运动之后、女性经期前后的血尿，可以先复查一次再定。收益记「小」，是因为只有检出率，没有「早查能降低多少死亡」的效应量。
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