Chronic Left Flank Discomfort and Hematuria with Normal Test Results
I'm a 36-year-old woman from the UK seeking insights into my persistent left-side flank pain and related urinary issues that have lasted for nearly four years, following complications from kidney stones and the subsequent placement of a ureteric stent. Despite visits to numerous urologists and gynecologists who have assessed me for stones and bladder functionality, no underlying problems have been identified. I've used GPT to condense my symptoms and medical background for clarity; however, I'm open to providing additional information if needed. ### Medical Background - Four years ago, I experienced an obstruction in my left kidney due to a stone measuring 5mm by 7mm. - I underwent surgery to have a ureteric stent placed since the stone was near the kidney. - The stent caused significant pain and heavy blood in the urine. - It remained in place for about three months before a second surgery for its removal, during which no stone was detected and it was assumed to have passed. - Post-surgery, I had a pain-free period lasting around six months. ### History of Endometriosis - I was diagnosed with endometriosis approximately 12 years ago, during which time I had three laparoscopic surgeries (two involved tissue removal and one was clear). - Earlier this year, I had my third procedure, where the surgeon removed endometriosis affecting both my ureters and ovaries. - After reviewing the surgical images again, the surgeon found no gynecological reason for my ongoing pain. ### Current Symptoms (Persisting for Approximately Four Years) - I now suffer from constant left flank pain on a daily basis. - **Pain Location:** * Flank area on the left side * Both the front and rear * Extends from beneath the ribs to the upper pelvic region, reaching towards the spine and at times towards the abdomen. - **Pain Characteristics:** * Profound internal pain (not arising from muscles or skin) * Exacerbated by physical activity and prolonged standing * Intensified when lying on the left side * Increased sensitivity around the affected area upon pressure - **Radiating Pain:** * Sometimes radiates into the groin * Can radiate down the left leg - **Associated Symptoms:** * Nausea during severe pain episodes * Urgency needing to urinate suddenly * Occasional involuntary loss of urine * Frequently cloudy urine ### Analysis of Urine - Ongoing urine tests over the years have revealed consistent: * Microscopic blood * Presence of leukocytes * Rare traces of protein - Multiple urine cultures have indicated no bacterial growth from any of the samples collected over four years. ### Investigations Conducted - Several CT scans, including those enhanced with contrast - Imaging of kidney function - Tests for bladder emptying **Findings:** - No stones detected - No obstructions identified - Kidney function and drainage appear normal - No structural abnormalities noted - The size of my kidney and the diameter of my ureter are within normal limits. ### Impact on Daily Life - The pain has become an everyday occurrence, significantly limiting my activities. - Symptoms intensify on days with more physical exertion. - This condition has negatively impacted my sleep and overall quality of life. - The feeling has shifted towards being progressively worse rather than improving. ### Insights from Specialists Thus Far - I have consulted multiple urologists. - I was informed that my symptoms might result from “post-stent pain,” after which I was discharged with no further assessments offered. - I was advised to simply manage the pain with morning medication. ### Concerns and Inquiries Considering my ongoing: - Chronic left-sided flank pain - Recurring microscopic blood in urine - Negative results from standard imaging - Urgent need to urinate - Past ureteric blockage and stenting - History of endometriosis surgery I am worried about potential conditions such as: - Renal vein compression syndromes (like Nutcracker syndrome) - Scar tissue or irritation in the ureter - Conditions causing loin pain and hematuria - Nerve-related pain - Bladder pain syndrome - Pelvic floor dysfunction I seek guidance on the following: 1. Should further investigations, such as Doppler ultrasound, CT/MR angiography, venography, or specialized pelvic imaging, be considered? 2. Which specialist should I consult next (nephrology, vascular surgery, interventional radiology, or a pelvic pain/endometriosis expert)? 3. What additional investigations or treatment options may be relevant in my situation? The conditions I've mentioned are what I've identified as possibilities in an effort to understand why my symptoms continue to worsen. I realize I may not be correct and any advice would be immensely appreciated.
Answers (1)
2/12/2026, 4:50:54 PM
OpenHealth AI
Thank you for sharing such a detailed account of your health journey. It’s clear that your chronic left flank pain and related urinary issues are frustrating and concerning. Based on your description, it seems that you are right to be proactive in seeking answers given your persistent symptoms and comprehensive history.
Main Points Summarized:
- You have chronic left flank pain and hematuria, lasting for nearly four years with no definitive diagnosis.
- You have undergone extensive testing with negative results, including imaging and urine analyses.
- You are considering potential conditions and further investigations.
Explanation:
The combination of chronic flank pain, hematuria (blood in urine), and ongoing urinary issues can stem from several complex causes, particularly after past kidney-related surgeries and endometriosis treatments. Conditions like Nutcracker syndrome or irritation/scarring due to stenting may not be readily visible in standard imaging but can still lead to significant discomfort. Additionally, your symptoms of increased sensitivity, urgency to urinate, and pain exacerbated by movement are notable.
Next Steps:
1. Consider Further Imaging:
- A Doppler ultrasound might be beneficial to assess for renal vein compression (Nutcracker syndrome) or other vascular issues affecting your kidneys.
- CT or MR angiography can offer a more detailed view of blood vessels around the kidneys.
- Pelvic imaging via specialized MRI could help evaluate for nerve-related issues or scar tissue in the pelvic area.
2. Consult with Relevant Specialists:
- Start with a nephrologist for a detailed assessment of your kidneys and urinary tract.
- Based on findings, you might also benefit from seeing a vascular surgeon if vascular compression is suspected.
- An interventional radiologist could be helpful if there's a need for specific imaging-guided interventions or recommendations based on the findings.
- Since your history includes endometriosis, consulting a pelvic pain specialist who understands both endometriosis and chronic pain management could provide additional avenues for treatment and management.
3. Document Your Symptoms:
- Keep a detailed log of your symptoms, including intensity, triggers, and any new developments. This can help specialists understand your condition better during consultations.
4. Explore Pain Management Options:
- Discuss the potential for medications that might aid in managing chronic pain, including nerve pain medications or physical therapy options to strengthen and support your pelvic and flank region.
Final Thoughts:
I recognize how challenging this situation has been for you, affecting not just your physical comfort but your overall quality of life. Seeking answers and understanding for your condition is a vital step, and considering further targeted investigations while consulting the appropriate specialists may help you uncover the underlying cause of your symptoms or offer better management strategies. Remember, you're not alone in this process; advocating for your health is crucial, and it’s commendable that you are actively seeking solutions.
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