Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: An initial clinical study

Abstract

Background: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods. 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. Results: 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. Conclusions: 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.

Benign lateralizing haematuria: the impact of upper tract endoscopy

“…Endoscopic access has also resulted in the discovery of new urothelial abnormalities that may be important in the pathogenesis of BLH. There are only a few publications reporting the use of upper tract endoscopy in the management of BLH (Table 2) [65–75].…”

“…TCCs, like submucosal haemangiomas, are readily identified endoscopically [76]. However, diffuse inflammatory lesions can be confused with high‐grade TCCs [77] or TCCs of unusual appearance [66]. Thus a biopsy should be taken from all lesions that are thought to be TCC or the appearances of which are inconclusive.…”

“…A pathological classi®cation of these lesions has not yet been possible because only a few reported lesions have been biopsied before endoscopic treatment and the histological assessment of these has been disappointing [66,69,70,72]. In the absence of histological evidence the responsibility of discrete endoscopic lesions for BLH has been inferred from the excellent outcomes obtained after ablative treatment [68,69,71,72].…”

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

“…13 Ureterorenoscopy combined with exfoliated cell cytology and multiple biopsies has been found to be the most accurate (89%) way to confirm the diagnosis with up to a 78% match between preoperative biopsy and surgical pathological grade but not so accurate in predicting the stage, as the lamina propria is sampled in only 66% of biopsies. 14,15 Although endoscopic biopsies are small, they are often sufficient to make a pathological diagnosis of the tumour grade.…”

Upper Urinary Tract Tumors: Which Diagnostic Methods Are Needed?

“…In some cases, active bleeding can be treated instantly [29] . However, for URS, Lopatkin et al [30] reported a diagnostic accuracy of only 58.5%.…”