Skip to main content

Acute and Chronic Flank Pain

  • Chapter
Genitourinary Pain And Inflammation

Part of the book series: Current Clinical Urology ((CCU))

Summary

Flank pain has multiple etiologies including but not exclusive to the genitourinary system. Treatment begins with a thorough history and physical examination. Before executing surgical treatment, the urologist would do best to evaluate a complete patient history, associated findings, and laboratory and radiologic tests to determine the cause of flank pain. A structured approach is recommended for diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Boxer, R. J., Fritzsche, P., Skinner, D. G. et al.: Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients. J Urol, 121 728, 1979

    PubMed  CAS  Google Scholar 

  2. Boxer, R. J., Skinner, D. G., Goodwin, W. E.: The ileal ureter in recurrent nephrolithiasis. Wis Med J, 78: 28, 1979

    PubMed  CAS  Google Scholar 

  3. Lindblad, B., Bergqvist, D., Kristiansen, P.: Bilateral renal autotransplantation with direct pyelocystostomy in a patient with frequent disabling nephroureterolithiasis. Case report. Scand J Urol Nephrol, 27: 413, 1993

    PubMed  CAS  Google Scholar 

  4. Oefelein, M. G., Bayazit, Y.: Chronic pain syndrome after laparoscopic radical nephrectomy. J Urol, 170: 1939, 2003

    Article  PubMed  Google Scholar 

  5. Weisberg, L. S., Bloom, P. B., Simmons, R. L. et al.: Loin pain hematuria syndrome. Am J Nephrol, 13: 229, 1993

    PubMed  CAS  Google Scholar 

  6. Dimski, D. S., Hebert, L. A., Sedmak, D. et al.: Renal autotransplantation in the loin pain-hematuria syndrome: a cautionary note. Am J Kidney Dis, 20: 180, 1992

    PubMed  CAS  Google Scholar 

  7. Bultitude, M., Young, J., Allan, J.: Loin pain haematuria syndrome: distress resolved by pain relief. Pain, 76: 209, 1998

    Article  PubMed  CAS  Google Scholar 

  8. Krauss, D. J., Khonsari, F., Lilien, O. M.: Incapacitating flank pain of questionable renal origin. Urology, 9: 61, 1977

    Article  PubMed  CAS  Google Scholar 

  9. Groen, G. J., Baljet, B., Boekelaar, A. B. et al.: Branches of the thoracic sympathetic trunk in the human fetus. Anat Embryol (Berl), 176: 401, 1987

    Article  CAS  Google Scholar 

  10. Ammons, W. S.: Renal afferent input to thoracolumbar spinal neurons of the cat. Am J Physiol, 250: R435, 1986

    PubMed  CAS  Google Scholar 

  11. Calaresu, F. R., Kim, P., Nakamura, H. et al.: Electrophysiological characteristics of renorenal reflexes in the cat. J Physiol, 283: 141, 1978

    PubMed  CAS  Google Scholar 

  12. North, R. B., Kidd, D. H., Petrucci, L. et al.: Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: Part II – clinical outcomes. Neurosurgery, 57: 990, 2005

    Article  PubMed  Google Scholar 

  13. Comiter, C. V.: Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol, 169: 1369, 2003

    Article  PubMed  Google Scholar 

  14. Ronk, L. L.: Spinal cord stimulation for chronic, nonmalignant pain. Ortho Nurs, 15: 53, 1996

    CAS  Google Scholar 

  15. Hieu, P. D., Person, H., Houidi, K. et al.: [Treatment of chronic lumbago and radicular pain by spinal cord stimulation. Long-term results]. Rev Rhum Ed Fr, 61: 271, 1994

    PubMed  CAS  Google Scholar 

  16. Catalano, O., Lobianco, R., Sandomenico, F. et al.: Real-time, contrast-enhanced sonographic imaging in emergency radiology. Radiol Med (Torino), 108: 454, 2004

    Google Scholar 

  17. Eknoyan, G., Qunibi, W. Y., Grissom, R. T. et al.: Renal papillary necrosis: an update. Medicine (Baltimore), 61: 55, 1982

    CAS  Google Scholar 

  18. McDougal, W. S., Kursh, E. D., Persky, L.: Spontaneous rupture of the kidney with perirenal hematoma. J Urol, 114: 181, 1975

    PubMed  CAS  Google Scholar 

  19. Gilsanz, V., Lozano, G., Jimenez, J.: Renal hydatid cysts: communicating with collecting system. AJR Am J Roentgenol, 135: 357, 1980

    PubMed  CAS  Google Scholar 

  20. Abraham, P. A., Halstenson, C. E., Opsahl, J. A. et al.: Suprofen-induced uricosuria. A potential mechanism for acute nephropathy and flank pain. Am J Nephrol, 8: 90, 1988

    Article  PubMed  CAS  Google Scholar 

  21. Curhan, G. C., Willett, W. C., Rimm, E. B. et al.: Family history and risk of kidney stones. J Am Soc Nephrol, 8: 1568, 1997

    PubMed  CAS  Google Scholar 

  22. Hammoud, D. A., Khoury, N. J., Haddad, M. C.: Unenhanced spiral CT scan in the initial evaluation of renal colic: AUBMC experience. J Med Liban, 49: 185, 2001

    PubMed  CAS  Google Scholar 

  23. Mendelson, R. M., Arnold-Reed, D. E., Kuan, M. et al.: Renal colic: a prospective evaluation of non-enhanced spiral CT versus intravenous pyelography. Australas Radiol, 47: 22, 2003

    Article  PubMed  Google Scholar 

  24. Chen, M. Y., Zagoria, R. J.: Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic? J Emerg Med, 17: 299, 1999

    Article  PubMed  CAS  Google Scholar 

  25. Chen, M. Y., Zagoria, R. J., Saunders, H. S. et al.: Trends in the use of unenhanced helical CT for acute urinary colic. AJR Am J Roentgenol, 173: 1447, 1999

    PubMed  CAS  Google Scholar 

  26. Smith, R. C., Verga, M., Dalrymple, N. et al.: Acute ureteral obstruction: value of secondary signs of helical unenhanced CT. AJR Am J Roentgenol, 167: 1109, 1996

    PubMed  CAS  Google Scholar 

  27. Fielding, J. R., Steele, G., Fox, L. A. et al.: Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. J Urol, 157: 2071, 1997

    Article  PubMed  CAS  Google Scholar 

  28. Ishikawa, I., Masuzaki, S., Saito, T. et al.: Magnetic resonance imaging in renal infarction and ischemia. Nephron, 51: 99, 1989

    PubMed  CAS  Google Scholar 

  29. Liu, Y. C., Wang, H. Y., Pan, J. S.: [Renal vein thrombosis in nephrotic syndrome – a prospective study of 54 cases]. Zhonghua Nei Ke Za Zhi, 28: 208, 1989

    PubMed  CAS  Google Scholar 

  30. Ellis, D.: Recurrent renal vein thrombosis and renal failure associated with antithrombin-III deficiency. Pediatr Nephrol, 6: 131, 1992

    Article  PubMed  CAS  Google Scholar 

  31. Theiss, M., Wirth, M. P., Dolken, W. et al.: Spontaneous thrombosis of the renal vessels. Rare entities to be considered in differential diagnosis of patients presenting with lumbar flank pain and hematuria. Urol Int, 48: 441, 1992

    PubMed  CAS  Google Scholar 

  32. Izumi, M., Yokoyama, K., Yamauchi, A. et al.: A young man with acute renal failure and severe loin pain. Nephron, 76: 215, 1997

    PubMed  CAS  Google Scholar 

  33. Morrissey, E. C., McDonald, B. R., Rabetoy, G. M.: Resolution of proteinuria secondary to bilateral renal vein thrombosis after treatment with systemic thrombolytic therapy. Am J Kidney Dis, 29: 615, 1997

    PubMed  CAS  Google Scholar 

  34. Bloemen, H., Verswijvel, G., Oyen, R.: Renal infarction as a cause of acute flank pain. Jbr-Btr, 83: 252, 2000

    PubMed  CAS  Google Scholar 

  35. Lam, K. K., Lui, C. C.: Successful treatment of acute inferior vena cava and unilateral renal vein thrombosis by local infusion of recombinant tissue plasminogen activator. Am J Kidney Dis, 32: 1075, 1998

    PubMed  CAS  Google Scholar 

  36. Lumerman, J. H., Hom, D., Eiley, D. et al.: Heightened suspicion and rapid evaluation with CT for early diagnosis of partial renal infarction. J Endourol, 13: 209, 1999

    PubMed  CAS  Google Scholar 

  37. Korzets, Z., Plotkin, E., Bernheim, J. et al.: The clinical spectrum of acute renal infarction. Isr Med Assoc J, 4: 781, 2002

    PubMed  Google Scholar 

  38. Leong, F. T., Freeman, L. J.: Acute renal infarction. J R Soc Med, 98: 121, 2005

    Article  PubMed  CAS  Google Scholar 

  39. Rodriguez Corchero, J., Villodres Duarte, A., Pena Outerino, J. M. et al.: [Segmental renal infarction presenting as acute flank pain]. Arch Esp Urol, 57: 756, 2004

    PubMed  Google Scholar 

  40. Pukenas, B., Zaslau, S.: Successful embolization of retroperitoneal bleeding from a renal angiomyolipoma. W V Med J, 99: 31, 2003

    PubMed  Google Scholar 

  41. Beyer, R. W., Daily, P. O.: Renal artery dissection associated with Gz acceleration. Aviat Space Environ Med, 75: 284, 2004

    PubMed  Google Scholar 

  42. Neuwirth, G., Kahler, A., Kereszter, P. et al.: [Renal papillary necrosis in a diabetic patient]. Orv Hetil, 142: 617, 2001

    PubMed  CAS  Google Scholar 

  43. Nies, A. S.: Renal effects of nonsteroidal anti-inflammatory drugs. Agents Actions Suppl, 24: 95, 1988

    Article  PubMed  CAS  Google Scholar 

  44. Lang, E. K., Macchia, R. J., Thomas, R. et al.: Multiphasic helical CT diagnosis of early medullary and papillary necrosis. J Endourol, 18: 49, 2004

    Article  PubMed  Google Scholar 

  45. Clark, W. R., Malek, R. S.: Ureteropelvic junction obstruction. I. Observations on the classic type in adults. J Urol, 138: 276, 1987

    PubMed  CAS  Google Scholar 

  46. Aragona, F., Camuffo, C., Passerini-Glazel, G.: Late development of pelviureteric junction obstruction (PUJO) in a girl with previously normal pyelogram: a case report. Int Urol Nephrol, 24: 491, 1992

    Article  PubMed  CAS  Google Scholar 

  47. Higuchi, A., Nakai, H., Miyazato, M. et al.: [Intermittent hydronephrosis. A clinical study in 23 pediatric patients]. Nippon Hinyokika Gakkai Zasshi, 87: 1145, 1996

    PubMed  CAS  Google Scholar 

  48. Matsumoto, S., Shimada, K., Hosokawa, S. et al.: [A clinical study of intermittent hydronephrosis]. Hinyokika Kiyo, 43: 703, 1997

    PubMed  CAS  Google Scholar 

  49. Kinn, A. C.: Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment. J Urol, 164: 652, 2000

    Article  PubMed  CAS  Google Scholar 

  50. Gotoh, M., Yoshikawa, Y., Nagai, T. et al.: Urodynamic evaluation of results of endopyelotomy for ureteropelvic junction obstruction. J Urol, 150: 1444, 1993

    PubMed  CAS  Google Scholar 

  51. Rucker, C. M., Menias, C. O., Bhalla, S.: Mimics of renal colic: alternative diagnoses at unenhanced helical CT. Radiographics, 24 Suppl 1: S11, 2004

    Article  PubMed  Google Scholar 

  52. Storm, D. W., Mowad, J. J.: Conservative management of a bleeding renal angiomyolipoma in pregnancy. Obstet Gynecol, 107: 490, 2006

    PubMed  Google Scholar 

  53. Moazzam, M., Ather, M. H., Hussainy, A. S.: Leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report. BMC Urol, 2: 13, 2002

    Article  PubMed  Google Scholar 

  54. Hodges, C. V., Barry, J. M.: Non-urologic flank pain: a diagnostic approach. J Urol, 113: 644, 1975

    PubMed  CAS  Google Scholar 

  55. Niv, D., Maltsman-Tseikhin, A.: Postherpetic neuralgia: the never-ending challenge. Pain Pract, 5: 327, 2005

    Article  PubMed  Google Scholar 

  56. Koch, P., Diedrich, O., Pennekamp, P. H. et al.: [Rare differenzial diagnosis of a radicular spine syndrome: herpes zoster radiculitis.]. Z Orthop Ihre Grenzgeb, 144: 583, 2006

    Article  PubMed  CAS  Google Scholar 

  57. Debat Zoguereh, D., Saadoun, R., Zandotti, C. et al.: AIDS-related varicella zoster meningoencephalitis and radicular pain without cutaneous eruption. Aids, 10: 1604, 1996

    Article  PubMed  CAS  Google Scholar 

  58. Gilden, D. H., Dueland, A. N., Devlin, M. E. et al.: Varicella-zoster virus reactivation without rash. J Infect Dis, 166 Suppl 1: S30, 1992

    PubMed  Google Scholar 

  59. Romero-Teran, O., Torres-Contreras, L. M., Mora-Fol, J. R. et al.: [Calcified renal artery aneurism and high blood pressure. A case report and review of the literature]. Cir Cir, 72: 217, 2004

    PubMed  Google Scholar 

  60. Rettedal, E. A., Vennesland, O.: [Ruptured abdominal aortic aneurysm. A rare form of presentation]. Tidsskr Nor Laegeforen, 113: 1470, 1993

    PubMed  CAS  Google Scholar 

  61. Chen, J. H., Chern, C. H., Chen, J. D. et al.: Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis. Emerg Med J, 22: 452, 2005

    PubMed  Google Scholar 

  62. Koroglu, M., Wendel, J. D., Ernst, R. D. et al.: Alternative diagnoses to stone disease on unenhanced CT to investigate acute flank pain. Emerg Radiol, 10: 327, 2004

    PubMed  Google Scholar 

  63. Choi, H., Snyder, H. M., 3rd, Duckett, J. W.: Urolithiasis in childhood: current management. J Pediatr Surg, 22: 158, 1987

    Article  PubMed  CAS  Google Scholar 

  64. Stothers, L., Lee, L. M.: Renal colic in pregnancy. J Urol, 148: 1383, 1992

    PubMed  CAS  Google Scholar 

  65. Paajanen, H., Tainio, H., Laato, M.: A chance of misdiagnosis between acute appendicitis and renal colic. Scand J Urol Nephrol, 30: 363, 1996

    Article  PubMed  CAS  Google Scholar 

  66. Iglesias-Casarrubios, P., Alday-Anzola, R., Ruiz-Lopez, P. et al.: [Lasegue’s test as prognostic factor for patients undergoing lumbar disc surgery]. Neurocirugia (Astur), 15: 138, 2004

    CAS  Google Scholar 

  67. Tokuhashi, Y., Matsuzaki, H., Uematsu, Y. et al.: Symptoms of thoracolumbar junction disc herniation. Spine, 26: E512, 2001

    Article  PubMed  CAS  Google Scholar 

  68. Deville, W. L., van der Windt, D. A., Dzaferagic, A. et al.: The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs. Spine, 25: 1140, 2000

    Article  PubMed  CAS  Google Scholar 

  69. Spencer, D. L.: The anatomical basis of sciatica secondary to herniated lumbar disc: a review. Neurol Res, 21 Suppl 1: S33, 1999

    PubMed  Google Scholar 

  70. Smith, S. A., Massie, J. B., Chesnut, R. et al.: Straight leg raising. Anatomical effects on the spinal nerve root without and with fusion. Spine, 18: 992, 1993

    Article  PubMed  CAS  Google Scholar 

  71. Kosteljanetz, M., Bang, F., Schmidt-Olsen, S.: The clinical significance of straight-leg raising (Lasegue’s sign) in the diagnosis of prolapsed lumbar disc. Interobserver variation and correlation with surgical finding. Spine, 13: 393, 1988

    Article  PubMed  CAS  Google Scholar 

  72. Traubici, J., Neitlich, J. D., Smith, R. C.: Distinguishing pelvic phleboliths from distal ureteral stones on routine unenhanced helical CT: is there a radiolucent center? AJR Am J Roentgenol, 172: 13, 1999

    PubMed  CAS  Google Scholar 

  73. Van Appledorn, S., Ball, A. J., Patel, V. R. et al.: Limitations of noncontrast CT for measuring ureteral stones. J Endourol, 17: 851, 2003

    Article  PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press

About this chapter

Cite this chapter

Noble, M.J. (2008). Acute and Chronic Flank Pain. In: Potts, J.M. (eds) Genitourinary Pain And Inflammation. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60327-126-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-126-4_2

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-816-4

  • Online ISBN: 978-1-60327-126-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics