title: Ureteroscopic evaluation and laser treatment of chronic unilateral hematuria.
abstract: OBJECTIVE
  Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. We evaluated patients with unilateral renal hematuria to determine the cause of bleeding and investigated the usefulness of ureteroscopic laser treatment for this condition.
  
  
  METHODS
  In a total of 23 patients with chronic unilateral hematuria radiology and hematology tests failed to reveal the source of hematuria since no abnormal findings could be detected. Preoperative urine cytology also showed no abnormalities. Subsequently all patients were investigated via ureteroscopy. In the case of a lesion being identified after complete inspection of the collecting systems the bleeding site was treated ureteroscopically with a holmium:YAG laser alone or in combination with a neodymium:YAG laser.
  
  
  RESULTS
  The entire ureter and intrarenal collecting systems were inspected in all patients. Discrete lesions were found via ureteroscopy in 18 patients, including minute venous rupture in 14, hemangioma on a renal papilla in 2 and calculus in 2. In the remaining 5 patients no lesions were detected by ureteroscopic evaluation. Nine of the 18 patients with detected lesions were treated ureteroscopically with the laser because active bleeding spots were recognized during the ureteroscopic procedure. In all treated patients hematuria resolved with no recurrence during a median followup of 73 months (range 18 to 110).
  
  
  CONCLUSIONS
  A patient in whom the cause of hematuria is unknown should undergo ureteroscopic evaluation. Ureteroscopic laser treatment is an excellent method for chronic unilateral hematuria.
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan. mugiya@hama-med.ac.jp
authors.forename: Soichi
authors.initials: S
authors.lastname: Mugiya
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ozono
authors.forename: Masao
authors.initials: M
authors.lastname: Nagata
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furuse
authors.forename: Tomomi
authors.initials: T
authors.lastname: Ushiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery; D006417:Hematuria / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery; D007674:Kidney Diseases / Q000175:diagnosis* / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012082:Renal Veins / Q000473:pathology / Q000601:surgery; D012422:Rupture, Spontaneous; D018666:Ureteroscopy