To assess the clinical value of tip-flexible ureteroscopy in the diagnosis of unilateral upper urinary tract hematuria.

The clinical data of 58 patients with unilateral upper urinary tract hematuria treated at the Department of Urology of Huai'an Hospital Affiliated to Xuzhou Medical University from January 2017 to June 2020 were retrospectively analyzed.

All the 58 patients completed the examination successfully. Among them, 19 (32.8%) patients were found to have neoplasms, including 12 males and 7 females. Pathological biopsy showed urothelial carcinoma. Their age ranged from 42 to 84 years old, with an average age of (63.8±7.9) years old. The tumor was located on the left side in 13 cases and on the right side in 6 cases; the tumor was located on the upper ureter in 5 cases, renal pelvis in 8 cases, and calyces in 6 cases; the pathological grade of tissue biopsy was high grade in 12 cases and low grade in 7 cases. 16 (27.6%) patients had microvascular rupture, 9 (15.5%) had angiomatous lesions, 4 (6.9%) had fibroepithelial polyps, 3 (5.2%) had variceal bleeding, and the remaining 7 (12.1%) had no lesions. The total detection rates of lesions by color Doppler ultrasound, CT urography (CTU), urine cytology, and tip-flexible ureteroscopy were 42.1%, 84.2%, 31.6%, and 100.0%, respectively; there was a significant difference between CTU and color Doppler ultrasound (χ²=7.24, P＜0.05) and urine cytology (χ²=10.08, P＜0.05), but there was no significant difference between CTU and tip-flexible ureteroscopy (χ²=3.26, P＞0.05). The overall coincidence rate of tip-flexible ureteroscopy biopsy and postoperative pathology was 84.2% (91.7% for high grade and 71.4% for low grade).

Tip-flexible ureteroscopy has clinical significance for the etiological diagnosis and treatment of unilateral upper urinary tract hematuria.