Cause of Upper Urinary-Tract Essential Hematuria: Veno-caliceal Fistula or Contralateral Coexistent Upper-Tract Transitional-Cell Carcinoma? Case Report

A 65-year-old woman was admitted with intermittent gross hematuria of 6 months' duration without other significant urinary-tract symptoms. At bilateral ureterorenoscopy under general anesthesia, a connection from an upper calix to the main left renal vein through a small venous channel was apparent, but there was no evidence of bleeding. In the right upper calix, a bleeding small papillary lesion was seen and ablated with low-power thulium laser coagulation. The histologic examination revealed a grade 3 stage pT1 TCC. Where no definite bleeding is seen from a veno-caliceal fistulous opening at ureterorenoscopy, it is imperative to inspect the entire contralateral upper urinary tract to exclude other causes of bleeding.