Gittes R F, Varady S
J Urol. 1981 Sep;126(3):297-300. doi: 10.1016/s0022-5347(17)54493-6.
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.
13例患者接受了肾探查联合肾镜检查，以定位并治疗慢性单侧肉眼血尿。6例患者出现反复的血凝块绞痛发作，1例需要多次输血，对癌症的持续恐惧或保险问题促使数名患者寻求转诊。所有患者均接受了出血检查、尿培养、细胞学检查、排泄性尿路造影、逆行肾盂造影和选择性肾血管造影。这些检查结果要么正常，要么未能确定出血来源。在保守治疗失败后，建议进行肾镜检查。在初步膀胱镜检查确认有活动性出血后进行手术肾镜检查，所有患者均确定了出血部位。5例患者发现了离散的黏膜下血管瘤，另外7例患者的出血可定位在1个肾盏。我们的患者中有12例行部分肾切除术，1例行肾切除术。迄今为止，这些患者均未再次出血。尽管进行了仔细的组织学检查，但仅在6份标本中发现了微小血管瘤。慢性肉眼血尿在身体和情感上都会使人丧失能力。在大多数（如果不是全部）此类病例中，明智地进行肾探查联合肾镜检查是必要的，保守性部分肾切除术有望治愈。
