World Congress of Endourology October 22-26, 2013

1. Ureteroscopy for Benign Essential Hematuria: A Systematic Review Nick N. Tadros, MD, Brian D. Duty, MD, Michael J. Conlin MD: Portland, OR Oregon Health Sciences University, Portland VA Medical Center World Congress of Endourology October 22-26, 2013 Introduction The advent of ureteroscopyhas revolutionized the treatment many urologic diseases, including benign essential hematuria (BEH). BEH is a diagnosis of exclusion when an obvious source cannot be determined through conventional radiologic and hematologic studies. This systematic review examines the treatment of BEH with ureteroscopicinterventions. Methods The search was performed of Medline, Ovid, Embase, and the Cochrane Collaboration Databases from 1977 to present. The search strategy was developed with a research librarian, and we included studies that used ureteroscopy to diagnose or treat BEH. Study selection was performed by reviewing the titles and abstracts of the citations identified from the search results. Data Extraction (including demographics, follow-up, findings, treatment method and success rate) was performed by one author and reviewed by the second. Quality analysis was performed independently by two of the authorsutilizing quality analysis tools developed for interventional series. Results 588 articles were reviewed and 15 included in the final analysis. No randomized controlled trials were found. All fifteen studies were case series. Nine studies were graded as good, five as fair, and one as poor. Follow-up ranged from 2 to 108 months. 307 patients underwent ureteroscopy for suspected BEH. 223 (73%) were diagnosed with a discrete lesion, 33 (11%) with a diffuse lesion, and 44 (14%) had no lesions seen on ureteroscopy. Of those diagnosed with discrete lesions, the most common was minute venous ruptures (35%), followed by hemangiomas (26%). Calculi and tumors made up 2% each. Fulguration was the most common treatment method used, followed by laser ablation. Of the 120 patients who underwent treatment for their discrete lesions, 115 (97%) who were treated endoscopically had resolution of their symptoms at follow-up. 19/33 (47%) patients had treatment for their diffuse lesions. Of these, 16 patients were treated endoscopically and 10 (53%) had resolution of hematuria. Interestingly, 10/14 (71%) of the patients with no lesions seen had resolution of their hematuria after ureteroscopy as well. Results with Ureteroscopy for Benign Essential Hematuria Conclusions BEH is rare and can be difficult to diagnose, but ureteroscopic treatment can yield excellent results. In this systematic review, 95% of patients with discrete lesions and 53% of patients with diffuse lesions had resolution of their hematuria after ureteroscopic interventions. Remarkably, ureteroscopy alone was therapeutic in 71% of patients where no lesion was visualized.