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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The current literature suggests that renal autotransplantation is nearly uniformly effective in controlling the severe and debilitating pain of the loin pain-hematuria syndrome (LPHS). However, we report two patients thought to have this syndrome in whom renal autotransplantation did not result in long-term control of pain. In case 1, autotransplantation resulted in immediate cessation of pain; however, the flank pain recurred 7 1/2 months later. The recurrent pain was also severe and debilitating, requiring narcotic medications for control. In case 2, autotransplantation of the left kidney resulted in chronic pain in the left pelvic area, the site of the autotransplanted kidney. In addition, the patient continued to experience chronic discomfort in the left flank and along the flank incision. One year after autotransplantation, the patient still requires multiple daily doses of narcotic medications for pain control. Our two patients represent the 13th and 14th reported patients subjected to renal autotransplantation for management of LPHS. They represent only the third and fourth reported patients with recurrence of pain after renal autotransplantation. Because studies with negative results are less likely to be reported in the literature than studies with positive results, it is possible that the literature overestimates the effectiveness of renal autotransplantation in the LPHS. To assess the true effectiveness of renal autotransplantation in LPHS, a survey of patients with LPHS who have undergone renal autotransplantation needs to be performed.
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PMID:Renal autotransplantation in the loin pain-hematuria syndrome: a cautionary note. 149 73

A retrospective analysis of 156 rigid ureteroscopic stone procedures in 145 patients revealed successful manipulation in 90%. The stone-free rate after adjunctive procedures was 95%. Access was achieved without balloon dilation in all but 18 patients. There were 24 perforations, occurring in 31% of proximal, 8% of mid ureteral and 8% of distal stone manipulations. Of the evaluable patients 63% underwent radiographic assessment for stricture disease, 75% at 6 months or more after the procedure. The stricture rate was 3.5% in all patients and 5.9% in patients with perforations. Of 37 patients evaluated for vesicoureteral reflux only 1 had reflux. Questionnaire followup was obtained for 74% of the patients (mean followup 2.6 years) and 32% felt normal within 3 days. Postoperative symptoms included flank pain (13%), renal colic (12%), pelvic discomfort (30%) and Double-J stent related complaints (49%). Of the patients 15% have reported recurrent stones. Ureteroscopy is effective and well tolerated, and it has minimal long-term complications.
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PMID:Ureteroscopy without routine balloon dilation: an outcome assessment. 156 57

The percutaneous nephrostomy tract has provided urologists with antegrade access to the upper urinary tract. Via this approach ureteropelvic junction obstruction has been treated with an endoscopically controlled incision with a cold knife. While less invasive than an open operation, we have noted significant discomfort from the 24 to 32F percutaneous tract. Accordingly, we sought to achieve the same results by using a less invasive approach, that is retrograde ureteronephroscopic endopyelotomy. A total of 10 patients (9 women and 1 man) with 5 primary and 5 secondary ureteropelvic junction obstructions underwent ureteroscopic endopyelotomy with a 3 or 5F Greenwald cutting electrode passed through a 12F rigid, 10.8F flexible or 9.8F flexible deflectable ureteronephroscope. Preoperatively, ureteropelvic junction obstruction was documented by a furosemide washout renal scan and/or a Whitaker test in 8 of 10 patients. In 2 patients an excretory urogram or retrograde pyelography was diagnostic. Duration of the procedure averaged 180 minutes (245 minutes with a concurrent Whitaker test). At the conclusion of the procedure a 7/14F indwelling ureteral stent was placed. The nephrostomy tube was removed after 3 days and average hospital stay was 5 days. The ureteral stents were routinely left in place for 6 weeks. Followup in 10 patients averaged 12 months. Flank pain was largely resolved in all patients. A followup Whitaker test, excretory urogram or renal scan ultimately has demonstrated decreased or no obstruction in 9 of 10 patients. In summary, early results with retrograde ureteronephroscopic endopyelotomy, specifically in female patients, appear to be promising. Morbidity is minimal and efficacy is satisfactory given the favorable objective response noted in 90% of the patients.
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PMID:Ureteronephroscopic endopyelotomy. 237 87

Double-pigtail stents are placed commonly in patients before extracorporeal shock wave lithotripsy to prevent ureteral obstruction from steinstrasse. The use of double-pigtail stents in lithotripsy patients with a moderate stone burden was studied in a prospective randomized trial. Patients with unilateral renal stone(s) with at least 1 diameter between 7 and 25 mm. were eligible for the study. Fifty patients were randomized to a control or stented group. Double-pigtail stents with an attached suture were placed immediately before extracorporeal shock wave lithotripsy in the stented group. Stents were removed by the patients 1 week after lithotripsy. A survey on pain and associated symptoms was completed by patients at 1 and 14 days after treatment. There was no statistical difference in flank or abdominal pain, nausea, vomiting, temperature or use of analgesics at 1 and 14 days after extracorporeal shock wave lithotripsy in the control and stented groups. All patients in the stented groups complained of side effects attributable to the stent including urinary frequency and urgency, bladder pain, hematuria and flank pain with urination. Of 25 patients with stents 7 (27%) had early removal because of severe irritation, early migration or accidental removal. Among the patients with follow-up x-rays 1 month after treatment 17 of 21 (81%) in the control group and 12 of 19 (63%) in the stented group showed no evidence of remaining stones. The use of double-pigtail stents is not beneficial in patients with a moderate stone burden. Double-pigtail stents are associated with considerable patient discomfort but no decrease in symptomatic ureteral obstruction or final stone eradication rate.
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PMID:Use of double-pigtail stents in extracorporeal shock wave lithotripsy. 240 62

Acquired cystic kidney disease (ACKD) is a complication of end-stage renal disease, the prevalence of which is related to dialysis duration; incidence of ACKD and associated conditions (neoplasia, hemorrhage) have decreased with improvements in renal transplantation and with the ageing of the dialysis population. This report regards spontaneous kidney rupture in a 57-year old patient, on home hemodialysis for 11 years, with ACKD for 5 years. At the end of a dialysis session, the patient reported sudden onset of colicky flank pain, followed by macrohematuria. Pain remitted with low doses of pain relievers, leaving dull flank discomfort. The patient self diagnosed a renal colic, and called the hospital two days later. At referral, two large hemorrhagic renal masses (7 and 2.8 cm) were found at ultrasound and CT scan. At surgery, kidney rupture was diagnosed. This case highlights the life threatening complications associated with ACKD, and underlines that massive renal hemorrhage may occur with relatively minor symptoms.
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PMID:Kidney rupture: an unusual and oligosymptomatic complication in a dialysis patient with acquired cystic disease. 1224 69

The nutcracker phenomenon refers to compression of the left renal vein between the aorta and the superior mesenteric artery. Clinical features are hematuria, abdominal pain, left flank pain, pelvic or scrotal discomfort due to varicocele or ovarian vein syndrome. In this report, 2 patients with orthostatic proteinuria, in whom nutcracker phenomenon was detected as a cause, are presented. One of them had posterior nutcracker with also asymptomatic varicocele that was detected during ultrasonographic examination. Nutcracker phenomenon is a rare but important clinical condition that should be considered in the differential diagnosis of patients with proteinuria and hematuria.
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PMID:The "nutcracker phenomenon" with orthostatic proteinuria: case reports. 1662 28

Actually ureteroscopy represents the therapy of choice for the treatment of ureteric stones. In the case of bilateral synchronous ureteric calculi the options are between a staged or a synchronous procedure; the last would potentially reduce costs and the need for a second anesthetic in comparison with a staged procedure. We reviewed our experience with bilateral same session ureteroscopy and compared with staged bilateral or unilateral procedure in the same series. The size and site of the stones were similar in all groups with a mean of 8.5 x 6.51 mm (15-7 x 10-5 mm). Symptoms were compared between the groups both before and after surgery, like painful urination, flank pain, urgency, nocturia, frequency, lower abdominal pain and urinary incontinence were assessed. A slight prevalence in the presence of hematuria was present in the bilateral same session URS group, probably due to the presence of the DJ stent. Urinary discomfort was more common in this group without reaching statistical significance (p>0.05). In no case differences between groups were statistically significant. No statistically significant differences were reported between the groups regarding postoperative pain (p>0.5). In our series, bilateral synchronous ureteroscopy is a safe procedure, with high stone free rate even compared with staged bilateral and monolateral treatment. It has the advantage of saving multiple procedures and the need of a second anesthesia and hospitalization. It can be performed safely with minimal risks. The positioning of a DJ stent at the end of the procedure adds little time, preventing post-operative complications with little discomfort for the patient.
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PMID:Bilateral same session ureteroscopy: safety and efficacy. 1748 99

Schwannoma is a rare tumor of neural crest cell origin. Most schwannomas occur in the head, neck, stomach or limbs, with a few cases occurring in the retroperitoneal space. A 30-year-old Taiwanese woman presented with a 1-week history of left anterior chest discomfort and left flank pain. The laboratory findings and endocrine studies were all within normal limits. Chest X-ray revealed masses in the posterior mediastinum. Chest computed tomography and magnetic resonance imaging showed several masses in the left paraspinal region and in the left adrenal region. The patient underwent total excision of the left paraspinal tumors and laparoscopic left adrenalectomy. Pathologic studies showed a picture of benign schwannoma. In conclusion, preoperative differentiation of benign schwannoma from malignant peripheral nerve sheath tumor or other tumors is important for good prognosis. Total excision of benign schwannoma is associated with favourable outcome in patients.
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PMID:Schwannomas of the left adrenal gland and posterior mediastinum. 1925 36

The placement of a ureteral stent is one of the most commonly performed urologic procedures. Indwelling ureteral stents are often accompanied by significant patient morbidity, including lower urinary tract symptoms, flank pain, and urinary tract infections. This article reviews the current state of ureteral stent technology developed to address the problem of stent discomfort and infection.
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PMID:Current status of ureteral stent technologies: comfort and antimicrobial resistance. 2042 92

A 52-year-old unvaccinated and splenectomized man presented with fever, altered sensorium, bilateral flank pain and chest discomfort accompanied with paroxysmal atrial fibrillation with a rapid ventricular response. An abdominal computed tomography scan was performed, which revealed a right renal infarct and splenosis. Transthoracic echocardiography was performed, which demonstrated an echodense structure on the mitral valve with mitral regurgitation and a vegetation on the aortic valve with aortic regurgitation. Subsequently, he was found to have pneumococcal infective endocarditis, pneumococcal pneumonia and bacterial meningitis, namely Austrian syndrome. He underwent an early aortic valve and mitral valve repair but still had a poor clinical outcome. Renal infarction has a mortality of approximately 13.2%, which is strongly influenced by the underlying diseases and infectious complications. Medical and surgical treatment initiated in a timely manner is often inadequate. The authors report the first case of Austrian syndrome presenting with renal infarction as a clue to an embolic event associated with infective endocarditis in this study.
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PMID:Renal infarction as a presentation of Austrian syndrome: thromboembolic phenomenon of pneumococcal endocarditis. 2273 59


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