Fleksibl üreterorenoskopi ile kronik unilateral hematürinin tanı ve tedavisi

Abstract

Amaç: Kronik unilateral hematüri intermittant veya devamlı olarak makroskopik hematüri ile karekterizedir ve standart görüntüleme yöntemleri, idrar sitolojisi yada hematolojik testler ile tanı konamaz. Sistoskopide unilateral hematürik idrar jeti görülür. Bu çalışmada kronik unilateral hematüri tanı ve tedavisinde fleksibl üreterorenoskopi ile Holmiyum lazerin etkinliği araştırılmıştır.

Gereç ve yöntemler: Radyolojik görüntüleme yöntemleri, idrar sitolojisi ve hematolojik testleri normal olan ve sistoskopide unilateral hematüri saptanarak fleksibl üreterorenoskopi yapılan yaş ortalaması 29.2 olan 4 hastanın verileri retrospektif olarak değerlendirildi.

Bulgular: Hastaların tümünde bütün kalikslere ulaşılarak kanama odağı bulundu ve Holmiyum lazer ile hemostaz uygulandı. Tüm hastalarda makroskopik hematüri kesildi. Ortalama 3.2 ay takip edilen hastalarda makroskopik hematürik nüks görülmedi.

Sonuç: Kronik unilateral hematürinin tanı ve tedavisinde fleksibl üreterorenoskopi ile Holmiyum lazer etkin bir yöntem olup ilk seçenek olarak düşünülmelidir.

Keywords

• böbrek
• hematüri
• lazer
• üreterorenoskopi

Flexible ureterorenoscopy in the diagnosis and treatment of chronic unilateral hematuria

Abstract

Aim: Chronic unilateral hematuria is characterized by intermittent or persistent macroscopic hematuria and can not be diagnosed with standart imaging modalities, urine cytology or hematologic tests. On cystoscopic examination unilateral hematuric urine jet is seen. In this study, the effectivity of flexible ureterorenoscopy with Holmium laser in the diagnosis and treatment of chronic unilateral hematuria was evaluated.

Material and methods: The data of 4 patients with a mean age of 29.2 years who underwent flexible ureterorenoscopy with normal radiological imaging, urine cytology and hematological tests and unilateral hematuria on cystoscopy were evaluated retrospectively.

Results: In all patients, entire caliceal system was reached and bleeding focus was hemostated with Holmium YAG laser. Hematuria disappeared in all patients. No macroscopic hematuric recurrence was revealed in the mean 3.2 months follow-up.

Conclusion: Flexible ureterorenoscopy is an effective method in the diagnosis and treatment of the chronic unilateral hematuria and should be concerned as a procedure of first choice.

Keywords

• kidney
• hematuria
• lasers
• ureterorenoscopy

References

1. 1. Marshall VF: Fiberoptics in Urology J Urol 1964;91:11.
2. 2. McMurty JM, Clayman RV, Preminger GM: Endourologic diagnosis and treatment of essential hematuria. J Endourol 1987;1:145-151.
3. 3. Kavoussi L, Clayman RV, Basler J: Flexible, actively deflectable fiberoptic ureterorenoscopy. J Urol 1989;142:949-954.
4. 4. Razvi HA, Chun SS, Denstedt JD et al: Soft-tissue applications of the Holmium:YAG laser in Urology. J Endourol 1995;9:387-390.
5. 5. Tanimoto R, Kumon H, Bagley D: Development of Endoscopic Diagnosis and Treatment for Chronic Unilateral Hematuria: 35 years Experience. J Endourol 2017;31:76-80.
6. 6. Hagen A: Renal angioma: four cases of angioma of the renal pelvis. Acta Chirurg Scand 1963;126:657-667.
7. 7. Vijan SR, Keating MA, Althausen AF: Ureteral stenosis after silver nitrate instillation in the treatment of essential hematuria. J Urol 1988;139:1015-1016.
8. 8. Stefanini M, English HA, Taylor AE: Safe and effective, prolonged administration of epsilon aminocaproic acid in bleeding from the urinary tract. J Urol 1990;143:559-561.

9. 9. Manjunath G, Fozailoff A, Mitcheson D et al: Epsilon aminocaproic acid and renal complications: case report and reviewof the literature. Clin Nephrol 2002;58:63-67.
10. 10. Nash DA Jr, Henry AR: Unilateral essential hematuria. Urology 1984;23:297-298.
11. 11. Lano MD, Wagoner RD, Leary FJ: Unilateral essential hematuria. Mayo Clinic Proceedings 1979;54:88-90.
12. 12. Araki M, Uehara S, Sasaki K et al: Ureteroscopic management od chronic unilateral hematuria: a single center experienceover 22 years. PLoS One 2012;7:e36729.
13. 13. Nakada SY, Elashry OM, Picus D et al: Long-term outcome of flexible ureterorenoscopy in the diagnosis and treatment of lateralizing essential hematuria. J Urol 1997;157:776-779.
14. 14. Mugiya S, Ozono S, Nagata M et al: Ureteroscopic evoluation and laser treatment of chronic unilateral hematuria. J Urol 2007;178:517-520.
15. 15. Brito AH, Mazzucchi E, Vicentini FC et al: management of chronic unilateral hematuria by ureterorenoscopy. J Endourol 2009;23:1273-1276.
16. 16. Takazawa R, Kitayama S, Tsujii T: Digital ureteroscopic visualization of lesions responsible for chronic unilateral hematuria, so-called idiopathic renal bleeding. Int J Urol 2014;21:227-8.