Hematuria, characterized by red blood cells in the urine, is a clinical symptom that demands an immediate investigation for potential urologic cancers, particularly in cases of gross hematuria. This study seeks to comprehensively review various urologic malignancies causing hematuria, such as urothelial carcinoma, renal cell carcinoma, and prostate ductal carcinoma. The review is anchored on the current urologic clinical guidelines and published literature.Current Concepts: Gross hematuria commonly signifies urologic cancer, with approximately 20% of gross hematuria cases and 5% of microscopic hematuria cases associated with a urologic cancer diagnosis. Cystoscopy and imaging studies of the upper urinary tract are recommended in patients presenting with gross hematuria, with urine cytology as a potential supplementary test. Conversely, in the presence of microscopic hematuria only, it is advisable to conduct appropriate tests while considering variables such as patient age. When hematuria occurs alongside antithrombotic drug administration, it is crucial not to forego appropriate testing due to the antithrombotic medication. Hematuria is a prevalent symptom of bladder cancer, renal cancer, and urothelial carcinoma; it can also be present in patients with prostate ductal carcinoma.Discussion and Conclusion: In instances of no urinary tract infection or other discernible cause of hematuria, a consultation with a urologist is recommended, irrespective of the patient’s age. When dealing with patients with urologic cancer, an early diagnosis is a critical factor influencing patient prognosis. Therefore, enhanced attention and a deeper understanding of urologic cancers that can precipitate hematuria are necessary.

Nephrectomy is performed for the treatment of kidney cancer or for the purpose of kidney transplantation. Generally, kidney function decreases after nephrectomy. It is well known that the incidence of cardiovascular disease increases and ultimately the mortality rate increases when kidney function decreases. Therefore, when renal mass is detected, partial nephrectomy (PN) is preferred over radical nephrectomy (RN) to preserve kidney function as much as possible. However, recent studies have shown that PN does not have a survival benefit in all patients compared to RN. Meanwhile, numerous studies for living kidney donors showed that kidney donation itself did not increase the risk of diabetes, high blood pressure, cardiovascular disease, and mortality. However, recent studies have shown that kidney donors have higher incidence of cardiovascular disease and higher mortality rates than the general populations. It is yet difficult to find a conclusion in these debates. We have to make a clinical decision rest on the balance of potential benefits and harms of competing treatments, personalized to the individual patient.

PURPOSE: The prognosis of patients with malignant pheochromocytoma is poor, but the predictive factors are not well understood. We aimed to identify the clinical characteristics predictive of malignancy after initial surgical removal in patients with pheochromocytoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 152 patients diagnosed with pheochromocytoma, including 5 (3.3%) with metastasis at the time of the initial surgical excision and 12 (7.9%) who developed metastasis during follow-up. To determine the factors predictive of malignancy, we compared clinical, radiographical, and urinary chemical findings between patients with benign and malignant disease. Mean follow-up was 41.5 months (range, 0.9-298 months) after surgery. RESULTS: Malignant tumors were significantly larger than benign tumors (11.1+/-4.0 cm vs. 6.2+/-3.4 cm, p<0.001), and postoperative persistence of arterial hypertension was more frequent after removal of malignant than benign tumors (p=0.001). Among the 147 patients without metastatic disease at diagnosis, those who developed metastasis had significantly lower concentrations of urinary catecholamine metabolites per unit of tumor, including vanillylmandelic acid (1.2 vs. 3.7 mg/day/cm, p=0.049), epinephrine (4.5 vs. 168.9 microg/day/cm, p=0.008), and norepinephrine (13.1 vs. 121.8 mg/day/cm, p<0.001). The overall 5-year metastasis-free survival rate was 84.4% and was significantly higher in patients with smaller tumors (< or =5.5 vs. >5.5 cm; 90.6% vs. 81.2%, p=0.025) and higher 24-hour secretion of vanillylmandelic acid (>2.1 vs. < or =2.1 mg/day/cm; 94.9% vs. 70.9%, p=0.019). CONCLUSIONS: Large tumor size (>5.5 cm) and minimally elevated 24-hour urinary vanillylmandelic acid (< or =2.1 mg/day/cm) were significantly associated with a higher probability of a malignant pheochromocytoma portending a lower metastasis-free survival and mandating more rigorous follow-up after surgery.
Adrenal Gland Neoplasms ; Catecholamines ; Epinephrine ; Follow-Up Studies ; Humans ; Hypertension ; Neoplasm Metastasis ; Norepinephrine ; Pheochromocytoma ; Prognosis ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Vanilmandelic Acid