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- Title
Ureteroscopic Management of Chronic Unilateral Hematuria: A Single-Center Experience over 22 Years.
- Authors
Motoo Araki; Shinya Uehara; Katsumi Sasaki; Koichi Monden; Masaya Tsugawa; Toyohiko Watanabe; Manoji Monga; Yasutomo Nasu; Hiromi Kumon
- Abstract
Objective: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. Methods: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (UromatTM). Lesions identified ureteroscopically were treated with diathermy fulguration. Results: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14–80) years and median follow-up of 139 (34–277) months. The median preoperative duration of gross hematuria was 5 (1–144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of ‘‘no lesions’’ was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. Conclusion: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.
- Publication
PLoS ONE, 2012, Vol 7, Issue 6, pe36729
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0036729