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Nephroscopy in chronic unilateral hematuria
Insights
Nephroscopy successfully identified bleeding sources in chronic unilateral gross hematuria cases unresponsive to other treatments. This renal exploration led to successful treatment and no recurrence in all patients.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Chronic unilateral gross hematuria presents diagnostic challenges.
- Standard investigations often fail to identify the bleeding source.
- Patients experience significant physical and emotional distress.
Observation:
- Thirteen patients with chronic unilateral gross hematuria underwent renal exploration with nephroscopy.
- Previous diagnostic studies including angiography were inconclusive.
- Nephroscopy was performed after failure of conservative management.
Findings:
- Nephroscopy precisely localized bleeding sites in all thirteen patients.
- Submucosal hemangiomas were identified in 5 patients; bleeding from a single calix in 7.
- Twelve patients underwent partial nephrectomy, one nephrectomy, with no recurrence to date.
Implications:
- Renal exploration with nephroscopy is a valuable tool for diagnosing and treating chronic gross hematuria.
- Conservative partial nephrectomy offers a curative solution.
- Early diagnosis and treatment can alleviate patient suffering and improve outcomes.
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.