Nephroscopy in chronic unilateral hematuria

Abstract

Thirteen patients underwent renal exploration with nephroscopy to localize and to treat chronic unilateral gross hematuria. Recurrent episodes of clot colic were noted in 6 patients, 1 required multiple transfusions and persistent fears of cancer or problems with insurability prompted several patients to seek referral. All patients had undergone bleeding studies, urine culture, cytology, excretory urograms, retrograde pyelograms and selective renal angiography. These studies either were normal or failed to identify the bleeding source. Nephroscopy was recommended after failure of conservative treatments. At operative nephroscopy, done after preliminary cytoscopy to confirm active bleeding, the bleeding sites were identified in all our patients. Discrete submucosal hemangiomas were found in 5 patients and the bleeding could be localized to 1 calix in 7 others. Of our patients 12 underwent partial nephrectomy and 1 had a nephrectomy. To date there has been no recurrence of bleeding in any of these patients. Despite careful histological examination microscopic hemangiomas could be found in only 6 of our specimens. Chronic gross hematuria can be disabling physically and emotionally. In most, if not all, such cases judicious renal exploration with nephroscopy is warranted and cure can be expected with conservative partial nephrectomy.