Management of chronic unilateral hematuria by ureterorenoscopy.
OBJECTIVE
Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. In the past, it was managed with partial or total nephrectomy. In the age of minimally invasive procedures, however, endoscopy has enabled more accurate diagnosis and management. We analyzed our experience with transurethral ureterorenoscopy using a flexible ureteroscope to determine the feasibility and success of endoscopic management of renal hematuria.


METHODS
We reviewed the records of 13 patients who presented with chronic unilateral hematuria, in whom radiologic and laboratory tests failed to reveal the source of bleeding. In the cases in which the lesion was identified, after complete inspection of the collecting systems, the bleeding site was treated ureteroscopically with a holmium: yttrium-aluminum-garnet (YAG) laser.


RESULTS
Follow-up ranged from 4 to 60 months (mean 26 mos). During the follow-up of the 13 patients, 11 remained symptom-free, with only one session of flexible ureterorenoscopy necessary. Relapse occurred in two patients after 4 months and 6 months, respectively; during a second session of flexible ureteroscopy, the bleeding site was successfully identified and cauterized with a holmium:YAG laser. No surgical complications occurred.


CONCLUSIONS
Conservative treatment of patients with chronic unilateral hematuria should always be considered. Laser ureteroscopic treatment is an excellent method and should be considered as the first option for the management of chronic unilateral hematuria.
Brito
Artur Henrique
AH
Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil. arturbrito@uol.com.br
Mazzucchi
Eduardo
E
Vicentini
Fabio Carvalho
FC
Danilovic
Alexandre
A
Chedid Neto
Elias Assad
EA
Srougi
Miguel
M
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006417:Hematuria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018666:Ureteroscopy