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Urinary Disorders

Ongoing right kidney pain after surgery for U

06/11/2007

Question:

I am a small-boned, fairly active 53 year old Caucasian woman. In 2004 I had laparoscopic pyeloplasty and multiple stone removal on my right kidney. I had been having pain on that side as well as considerable blood in my urine. Hydronephrosis was termed "moderate" on my radiology reports.

Since surgery my pain has worsened. The hydronephrosis is still showing "mild to moderate" although no blockage is showing. It is apparent that my right kidney falls almost to my pelvis at times, and two urologists have said the pain might be due to the ureter twisting intermittently, although it has not been twisted on either of two IVPs taken , one sitting, one standing. Neither doctor recommended the corrective surgery for this floating kidney, although both mentioned it.

The pain is never gone, and at times it has required emergency room visits for morphine. I went to the hospital pain clinic nearly every month for a year for steroid injections in my right lumbar areas, and even had some nerves destroyed. It helped temporarily, with each treatment lasting for about 2-3 weeks. The pain in the kidney itself did not improve.

Is there something my doctors aren`t telling me about the surgery to stabilize the kidney? What causes hydronephrosis other than a blockage?

I really need help with this. It`s been two and a half years. My nerves are shot. Do you have any suggestions?

Answer:

Mild to moderate hydronephrosis without the presence of blocking stone is usually caused by blockage of the urine at the ureteral level. Most often it is due to congenital ureteropelvic junction obstruction. This condition is sometimes due to a crossing vessel at the junction and not necessarily an anatomical condition. It may also be associated with kidney stone disease like in your case.

The other condition, which is not that common is called Nephroptosis in which the kidney has less supporting tissue around it and kidney moves downward as the person is standing. If the condition is associated with a crossing vessel under the ureter a temporary blockage can result and hence pain and hydronephrosis. This condition can be treated with fixation of the kidney(Nephropexy) and also repositioning or dividing the crossing vessel.

There are many other causes for flank pain as well. Hydronephrosis could have been present without blockage, which is called Megacalicosis. This condition is not treatable and should not cause transient pain.

Talk to your doctor about the crossing vessel. He or she may perform a test called CT urogram which may show the vessel.

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Response by:

Ahmad  Hamidinia, MD Ahmad Hamidinia, MD
Formerly, Professor of Clinical Surgery
College of Medicine
University of Cincinnati