Endoscopic management of renal hemangioma

Renal hemangioma is a rare clinical entity that is difficult to diagnose. In the past it was treated with partial or complete nephrectomy. However, in the age of minimally invasive procedures endoscopy has enabled more accurate diagnosis and management. We reviewed our experience with transurethral ureterorenoscopy using a flexible ureteroscope to determine the feasibility and success of endoscopic treatment of renal hemangioma.

We reviewed the records of 15 patients with a mean age of 37.5 years who presented with recurrent lateralized gross hematuria and were diagnosed with renal hemangioma based on transurethral ureterorenoscopy using a flexible ureteroscope. Lesions were treated using a 2 or 3Fr electrocautery probe, or a 200 mu. laser fiber with holmium or neodymium:YAG energy.

Followup was 2 to 96 months (mean 20.2). Of the 15 cases 14 were successfully managed by endoscopy. A single patient initially treated with endoscopy in 1988 underwent partial nephrectomy shortly thereafter secondary to continued bleeding. No patient had any complication related to the procedure. All except 1 of the 12 patients on whom followup data were available remain free of any hematuria.

When the source of unilateral hematuria is unknown or in doubt, particularly in young patients, the diagnosis of a hemangioma should be considered. Transurethral ureterorenoscopy using a flexible ureteroscope is an excellent method of visualizing the offending lesion and safely treating it using an electrocautery probe or laser fiber.