Chronic Unilateral Hematuria: Compound Papillae Are Likely to Bleed

The present study investigated the recent outcomes of chronic unilateral hematuria (CUH), focusing on the detailed distribution of bleeding points based on the anatomical classification of the pelvicaliceal system. We evaluated 75 CUH patients treated in the past decade. Bleeding points were recorded separately as five levels of minor calices (Top, Upper, Middle, Lower, and Bottom). Bleeding point detection, immediate success, and recurrence-free rates were assessed. The median age was 47 (range: 13-81) years. Bleeding points were detected in 62 patients (83%), including at the Top calix in 24 patients (32%), the mid-calices (Upper, Middle, and Lower) in 20 patients (27%), and the Bottom calix in 18 patients (24%). As there are typically six total calices in the mid calices, the probability of bleeding per renal papilla was higher in the compound papillae at the Top and Bottom calices than in the simple papilla at the mid calices. The bleeding point detection rate was significantly higher in the 65 patients with confirmed unilateral gross hematuria than in the 10 patients without confirmation (88% vs 50%, p < 0.01). The immediate success rate was 97% (73/75), and only two patients (3%) needed a second ureteroscopy. Ultimately, all patients achieved the disappearance of gross hematuria, including 13 patients (17%) whose bleeding points were not identified by ureteroscopy. The recurrence-free rate was 100% at a median follow-up of 42 (3-139) months. Compound papillae are more likely to bleed than simple papillae. Therefore, we recommend evaluating the Top and Bottom calices carefully during the initial ureteroscopic observations. Since the patients with confirmed gross hematuria from the unilateral orifice had a higher rate of bleeding point detection than those without confirmation, it is important to perform cystoscopy while the bleeding is persistent.