BACKGROUND The management of chronic unilateral hematuria (CUH) caused by benign lesions is a therapeutic challenge to many urologists. The aims of this study were to evaluate the efficacy and safety of povidone iodine sclerotherapy for CUH. MATERIAL AND METHODS We identified 20 patients who underwent povidone iodine sclerotherapy to treat CUH between September 2013 and August 2017. Radiologic and hematologic tests were normal, no definite cause of hematuria was revealed, and the malignant lesions were excluded. Cystoscopy and ureteroscopy indicated the lesions were located in the renal pelvis. The goal of successful treatment was no recurrence of hematuria during follow-up. RESULTS The present study analyzed 20 patients (9 females and 11 males), 24-73 years old (mean age 44.6) with mean follow-up of 23.8 (range 13-60) months. Endoscopic findings included discrete lesions, diffuse lesions, and no obvious lesion. Discrete lesions were identified as hemangioma (4/20, 20%), minute venous rupture (12/20, 60%), and varix (1/20, 5%). Diffuse lesions were founded via ureteroscopy in 2 (2/20, 10%) patients. In the remaining 1 (1/20, 5%) patient, no obvious lesion was found. All patients with CUH were treated with 0.5% povidone iodine for pelvicalyceal system instillation, which was given at 12-h intervals for 3 days. Only 1 patient experienced recurrent gross hematuria, after 24 months postoperatively. The overall success rate, defined as resolution of gross hematuria after povidone iodine sclerotherapy, was 95%. No complications were recorded. CONCLUSIONS The present study indicates that povidone iodine sclerotherapy could be an effective, safe, and minimally invasive treatment for chronic unilateral hematuria caused by benign lesions.