UROGENITAL PAIN SYNDROMES (also see Chapter 73 )

Pain syndromes of the urogenital system result from inflammatory disease, anatomic anomalies, obstructive uropathy, and malignancies. The visceral type of renal pain is frequently caused by pyelonephritis or ischemic events secondary to an embolus or a thrombus. The hematuria in sickle cell disease or sickle cell trait is typically painless. The site of pain, the characteristics of referred pain, and the quality of pain help the clinician identify the source of pain.

Benign Renal Neoplasms

Flank pain is a common symptom in adults with angiomyolipoma (more common in women than men) and in children with mesoblastic nephroma and Wilms' tumor or nephroblastoma. Nephroblastomas may be combined with several congenital malformations such as sporadic anhidrosis (lack of sweating), microcephaly, mental retardation, and spina bifida. Treatment consists of surgical resection of the tumor supplemented by chemotherapy and adequate pain management. Opiates are the mainstay of pain management.