Yazaki T, Kamiyama Y, Tomomasa H, Shimizu H, Okano Y, Iiyama T, Iizumi T, Umeda T
Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.
Int J Urol. 1999 May;6(5):219-25. doi: 10.1046/j.1442-2042.1999.00057.x.
To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods.
Fifteen patients with upper tract hematuria of unknown etiology were the subjects of the present study. Prior to ureteropyeloscopy, they underwent standard diagnostic methods, including cystourethroscopy, excretory urography and computed tomography scan. The upper tract (ureter, renal pelvis and calyces) was inspected systematically with a flexible ureteropyeloscope under epidural anesthesia. A biopsy specimen was obtained when neoplasm of a suspicious lesion was seen. Bleeding and hemangiomatous lesions were fulgurated at the time of ureteropyeloscopy.
Unilateral gross hematuria was seen in 12 patients. Imaging studies revealed a filling defect in four patients, ureteral stenosis in one patient and nutcracker phenomenon in one patient. Urine cytology was positive in three patients and suspicious in four patients. Results of ureteropyeloscopy were papillary tumor in three patients, whitish encrustation in one patient, redness of the renal pelvis in one patient, bleeding from the renal calyx in two patients, hemangiomatous lesion in one patient, ureteral stenosis in two patients and no abnormalities in five patients. Biopsies were performed in five patients. The pathology results were transitional cell carcinoma in four patients and no abnormality in one patient. Although a ureteral stent catheter was placed in one patient, no serious complications were encountered during or after the procedures.
Ureteropyeloscopy was useful and relatively safe. This endoscopic examination can differentiate insignificant lesions from significant lesions by visual inspection of the lesions, in addition, pathological diagnosis by biopsy specimen can also be performed if deemed necessary. Ureteropyeloscopy is recommended in the diagnosis of upper tract hematuria of unknown etiology.
通过标准诊断方法研究输尿管肾盂镜检查在不明原因上尿路血尿诊断中的有效性和安全性。
本研究以15例不明原因上尿路血尿患者为研究对象。在进行输尿管肾盂镜检查前，他们接受了标准诊断方法，包括膀胱尿道镜检查、排泄性尿路造影和计算机断层扫描。在硬膜外麻醉下，使用可弯曲输尿管肾盂镜对尿路（输尿管、肾盂和肾盏）进行系统检查。当发现可疑病变的肿瘤时，获取活检标本。在输尿管肾盂镜检查时，对出血和血管瘤样病变进行电凝治疗。
12例患者出现单侧肉眼血尿。影像学检查显示4例患者有充盈缺损，1例患者有输尿管狭窄，1例患者有胡桃夹现象。3例患者尿细胞学检查呈阳性，4例患者可疑。输尿管肾盂镜检查结果为3例患者有乳头状肿瘤，1例患者有白色结痂，1例患者肾盂发红，2例患者肾盏出血，1例患者有血管瘤样病变，2例患者有输尿管狭窄，5例患者无异常。5例患者进行了活检。病理结果为4例患者为移行细胞癌，1例患者无异常。虽然1例患者放置了输尿管支架导管，但在手术期间或术后未遇到严重并发症。
输尿管肾盂镜检查是有用且相对安全的。这种内镜检查可通过对病变的目视检查区分无意义病变和有意义病变，此外，如有必要，还可通过活检标本进行病理诊断。对于不明原因上尿路血尿的诊断，推荐使用输尿管肾盂镜检查。
