Does this case hold the answer to one of the worse types of pain in medicine—that of loin pain haematuria syndrome (LPHS)

Article, 0038 English OPEN
Russell, Alan ; Chatterjee, Suman ; Seed, Michael (2015)
  • Publisher: BMJ Publishing Group
  • Related identifiers: doi: 10.1136/bcr-2014-209165
  • Subject: Article
    mesheuropmc: urologic and male genital diseases | female genital diseases and pregnancy complications

A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain\ud overlaid with prolonged periods of incapacitating colic and overnight vomiting was\ud presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral\ud stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal,\ud and bloody urine effluxed from the left ureteric orifice. The ureters were normal at\ud diagnosis, and developed new abutting non‐penetrating calcifications by 8 months. Pain\ud episodes of complete incapacitating intensity of 2–4 h duration were reduced to 10 min\ud with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the\ud original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the\ud exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm\ud of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain\ud exacerbations in this case of loin pain haematuria syndrome.
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