Exploration and Endoscopic Treatment of Unilateral Primary Haematuria: Is Non-Specific Diffuse Pyelitis a Real Entity?

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].…”

“…New endoscopic pelvicalyceal lesions have been described in 45% of cases (Table 3). These include minute venous ruptures [68,72], peripapillary varices and bleeding [70,71], abnormal configuration of the papillary tip [68,71], dilated collecting ducts [71], isolated and diffuse petechiae [70], focal and diffuse erythema [68,69,71,75], inflammation [74], and hyperaemia [72]. They have been divided intuitively into those that are discrete, well‐defined, and localized usually to a papilla or fornix (21%), and those that are less well defined and diffuse, usually involving the renal pelvis and infundibulae as well as the calyces (24%).…”

“…The use of the new third‐generation flexible fibre‐optic ureterorenoscopes, incorporating a passively deflectable segment proximal to the actively deflectable distal segment, has resulted in an increase in the proportion of cases in which there was a complete examination, and a corresponding reduction in the proportion of cases with a negative endoscopy (Table 3) [78]. Second, it was suggested that even with a complete examination, small lesions may be missed [70]. Some investigators consider that the absence of active bleeding increases the chances of missing small lesions, as bleeding focuses the exploration, and (because it is venous) can be controlled by varying the irrigation pressure so as not to obscure vision [72].…”

“…Endoscopic treatment is the mainstay of the management for BLH [69–72] and should be differentiated from retrograde treatments that include lavage of the renal pelvis with contrast medium, methylene blue or adrenaline [55,57], and tamponade of the upper tract with occluded ureteric catheters or balloon catheters designed for ureteric dilation [79,80].…”

“…New endoscopic pelvicalyceal lesions have been described in 45% of cases (Table 3). These include minute venous ruptures [68,72], peripapillary varices and bleeding [70,71], abnormal con®guration of the papillary tip [68,71], dilated collecting ducts [71], isolated and diffuse petechiae [70], focal and diffuse erythema [68,69,71,75], in¯ammation [74], and hyperaemia [72].…”