Cytoscopic evaluation results in patients presenting with symptoms of macroscopic hematuria

Subject The aim of this study was to analyze the results of cystoscopic evaluation in children who presented with symptoms of hematuria and whose etiology could not be clarified by imaging methods. Method Patient records were identified and analyzed retrospectively from the 2010–2021 for this study. Results A total of 23 patients, 21 boys and 2 girls, were identified who underwent cystoscopy due to hematuria. The mean age of the patients was 10.1 ± 3.9 years. There was blood in urine in 16 patients, and bleeding in the form of dripping after urination in 7 patients. There were no findings to explain the etiology of hematuria in the radiological imaging and nephrological evaluations of these patients. Cystoscopy was performed 25 times in 23 patients. Cystoscopy of three patients was normal. Of the other patients, 14 had posterior urethritis, 2 had posterior urethral valve (PUV), 2 had anterior urethritis, 1 had vesicular lesion in the bladder and one patient had bladder trabeculation. Biopsies were taken from the bladder in two patients and from the urethra in another two. Histopathological findings demonstrated mixed inflammatory cells, sparsely reactive urothelial cells, nephrogenic metaplasia, and chronic inflammation. Steroid instillation into the urethra was performed 11 times in 9 patients: and symptoms of five patients disappeared after instillation. Steroid instillation was planned for two patients, and 2 patients who underwent instillation did not come to the outpatient clinic for follow-up after the procedure. Conclusion Hematuria is common in children. In patients with recurrent, long-lasting or in whom the etiology cannot be determined by imaging methods such as blood and urine tests, cystoscopic evaluation provides the possibility of therapeutic intervention in addition to revealing or excluding possible pathologies. Intraurethral administration of steroids in urethritis of unknown origin was successful in the majority of patients in this series.