EXPLORATION AND ENDOSCOPIC TREATMENT OF UNILATERAL PRIMARY HEMATURIA - IS NONSPECIFIC DIFFUSE PYELITIS A REAL ENTITY

Chronic unilateral primary haematuria is rare and raises difficult pro blems of diagnosis and treatment as most of the knowledge in this fiel d has been based on a very limited number of patients. This clinical e ntity needs critical reevaluation as recent progress in endourological investigations has revealed that lesions other than the classical sub mucosal haemangioma are just as frequently responsible for unilateral primary haematuria. These endoscopic lesions have generally been poorl y defined up to now and our data based on a retrospective review of 8 patients emphasises the persistent gaps in our understanding of the pa thophysiology of this disease. Among the lesions responsible for unila teral primary haematuria, diffuse petachiae of the renal pelvis and ca vities represent the most frequent endoscopic lesion described in our experience (50% of cases). Histologically, these diffuse lesions corre spond to non-specific pyelitis, consisting of simple oedema of the lam ina propria. In addition to its diagnostic role, endoscopy can also be used to effectively treat the lesions responsible for unilateral prim ary haematuria, using either electrocoagulation or nitrate cautery, pr ovided a retrograde approach can be completed by a percutaneous approa ch, with an overall success rate of 75% of cases with a mean follow-up of 16 months.