Mugiya Soichi, Ozono Seiichiro, Nagata Masao, Takayama Tatsuya, Furuse Hiroshi, Ushiyama Tomomi
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Urol. 2007 Aug;178(2):517-20. doi: 10.1016/j.juro.2007.03.098. Epub 2007 Jun 14.
Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. We evaluated patients with unilateral renal hematuria to determine the cause of bleeding and investigated the usefulness of ureteroscopic laser treatment for this condition.
In a total of 23 patients with chronic unilateral hematuria radiology and hematology tests failed to reveal the source of hematuria since no abnormal findings could be detected. Preoperative urine cytology also showed no abnormalities. Subsequently all patients were investigated via ureteroscopy. In the case of a lesion being identified after complete inspection of the collecting systems the bleeding site was treated ureteroscopically with a holmium:YAG laser alone or in combination with a neodymium:YAG laser.
The entire ureter and intrarenal collecting systems were inspected in all patients. Discrete lesions were found via ureteroscopy in 18 patients, including minute venous rupture in 14, hemangioma on a renal papilla in 2 and calculus in 2. In the remaining 5 patients no lesions were detected by ureteroscopic evaluation. Nine of the 18 patients with detected lesions were treated ureteroscopically with the laser because active bleeding spots were recognized during the ureteroscopic procedure. In all treated patients hematuria resolved with no recurrence during a median followup of 73 months (range 18 to 110).
A patient in whom the cause of hematuria is unknown should undergo ureteroscopic evaluation. Ureteroscopic laser treatment is an excellent method for chronic unilateral hematuria.
慢性单侧血尿的特征为间歇性或持续性肉眼血尿，采用标准放射学和血液学方法无法确诊。我们对单侧肾血尿患者进行评估以确定出血原因，并研究输尿管镜激光治疗这种病症的有效性。
共有23例慢性单侧血尿患者，放射学和血液学检查未能揭示血尿来源，因为未检测到异常发现。术前尿细胞学检查也未显示异常。随后，所有患者均通过输尿管镜进行检查。在对集合系统进行全面检查后若发现病变，对出血部位单独使用钬：钇铝石榴石激光或联合钕：钇铝石榴石激光进行输尿管镜治疗。
对所有患者的整个输尿管和肾内集合系统进行了检查。通过输尿管镜检查在18例患者中发现了离散性病变，包括14例微小静脉破裂、2例肾乳头血管瘤和2例结石。在其余5例患者中，输尿管镜评估未发现病变。18例发现病变的患者中有9例在输尿管镜检查过程中发现有活动性出血点，因此接受了输尿管镜激光治疗。在所有接受治疗的患者中，血尿均消失，在中位随访73个月（范围18至110个月）期间无复发。
血尿原因不明的患者应接受输尿管镜评估。输尿管镜激光治疗是慢性单侧血尿的一种极佳方法。
