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

Russell, Alan; Chatterjee, Suman; Seed, Michael

doi:10.1136/bcr-2014-209165

Cited by 10 publications

(9 citation statements)

References 14 publications

(11 reference statements)

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“…Previous studies have indicated that the PDE-5 inhibitors might be useful in the treatment of CPP [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

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Is Tadalafil an Effective Treatment Option for Interstitial Cystitis/Painful Bladder Syndrome? A Report of a Challenging Case

Demirtaş¹,

Sönmez²,

Tombul³

et al. 2021

Cureus

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Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pelvic pain (CPP) syndrome that is frequently seen in female patients. Since its molecular mechanism and etiopathogenesis are not clearly elucidated, its treatment options are limited. Phosphodiesterase-5 (PDE-5) inhibitors act on nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) and are an effective treatment option in some CPP syndromes. We discuss the case of a 44-year-old female patient who presented to our clinic with a two-year history of frequent urination and pain in the pelvic area. The cystoscopy of the patient, who did not benefit from first-and second-line treatments, was normal. With the diagnosis of IC/PBS, she was started on tadalafil (oral) 5 mg/day. At the end of a total of 12 months of follow-up, it was observed that the patient's symptoms significantly regressed.Based on our findings, the relaxing effect of PDE-5 inhibitors on the bladder neck/detrusor muscle and the vasodilator effect on the blood supply to the pelvic organs may have improved the patient's symptoms. In this case report, for the first time in the literature, we present the clinical outcomes of treatment with tadalafil (5 mg/day), which is a PDE-5 inhibitor, in a female patient with IC/PBS who did not respond to first-and second-line treatments. The results indicated that tadalafil, which shows activity through the NO-cGMP and prostaglandin pathway, is a potential alternative in IC/PBS patients resistant to conventional first-and second-line treatments.

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“…Previous studies have indicated that the PDE-5 inhibitors might be useful in the treatment of CPP [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Based on this mechanism of action, many studies have suggested that PDE-5 inhibitors are effective in treating CPP. Tadalafil and sildenafil are among the most commonly used PDE-5 inhibitors [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Is Tadalafil an Effective Treatment Option for Interstitial Cystitis/Painful Bladder Syndrome? A Report of a Challenging Case

Demirtaş¹,

Sönmez²,

Tombul³

et al. 2021

Cureus

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“…Considering the ill-defined nature of the pain, the crucial consideration for the diagnosis and treatment of LPHS is to identify the origin of the pain. Our first clue came from a 2015 publication by Russell and colleagues, 8 which described a male patient who presented with typical symptoms of LPHS. This patient was treated with tadalafil 5 mg/day, which reduced his pain score by several points.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was treated with tadalafil (Cialis, Lilly USA, Indianapolis, IN, USA), which is known to relax the smooth muscle cells of the urogenital tract. 8 The patient’s pain score improved dramatically, which led us to the hypothesis that, regardless of the cause of LPHS, the ureter is the final target organ. To prove our hypothesis, we developed the “UW-LPHS test.” Here, we describe the diagnostic procedures of LPHS in 6 patients who underwent the UW-LPHS test followed by renal autotransplant.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Sollinger

Al‐Qaoud²,

Bath³

et al. 2018

Exp Clin Transplant

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Objectives: The objectives of this pilot study were twofold. First, we aimed to elicit whether the “UW-LPHS test” definitively localizes pain from patients’ loin pain hematuria syndrome to the ureter and thus proves our hypothesis. Second, we aimed to understand whether a positive UW-LPHS test predicts a successful outcome after renal autotransplant. Materials and Methods: The UW-LPHS test is described in detail in this manuscript. Briefly, 0.5% bupivacaine is injected into the ureter of the affected side and kept there using a balloon catheter for 5 minutes. Results: All six patients studied had complete pain relief at a mean follow-up of 9.2 months after renal autotransplant. All patients were successfully weaned from opioids and have returned to a normal lifestyle. Conclusions: The UW-LPHS test can be used to predict renal autotransplant outcomes and should be applied to all patients who are being considered for this operation.

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“…After receiving tadalafil (Cialis, Lilly USA, Indianapolis, IN, USA), which functions as a smooth muscle relaxant of the urogenital system, the patient experienced a dramatic improvement in his pain. 20 This case highlights the fact that ultimately, the ureter may be the origin of pain in LPHS. To support this hypothesis, we developed the UW-LPHS test as a diagnostic study to identify patients who may experience pain relief following renal autotransplant.…”

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confidence: 83%

Commentary: Loin Pain Hematuria Syndrome

Bath

Williams

Sollinger

et al. 2018

J Rare Dis Res Treat

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Loin Pain Hematuria Syndrome (LPHS) remains a rare disease but has a significant impact on those affected by it. Patients diagnosed with LPHS experience severe, constant or intermittent flank pain that radiates to the groin and may be exacerbated even by a gentle touch. These patients often require significant narcotic regimens for pain control and are unable to maintain a functional lifestyle. Previously, diagnosis has been made based on clinical presentation. One treatment for this syndrome is renal autotransplant; however, success rates are varied. Therefore, patient selection for this procedure is important. We have developed the UW-LPHS test as a diagnostic maneuver in order to determine which patients with LPHS would benefit from renal autotransplant. To perform this diagnostic test, bupivacaine is instilled into the ureter on the affected side and left to dwell. Patients who experience pain relief following this test are deemed to benefit from renal autotransplant. Here we describe this novel diagnostic test and initial success rates following renal autotransplant.

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

Cited by 10 publications

References 14 publications

Is Tadalafil an Effective Treatment Option for Interstitial Cystitis/Painful Bladder Syndrome? A Report of a Challenging Case

Is Tadalafil an Effective Treatment Option for Interstitial Cystitis/Painful Bladder Syndrome? A Report of a Challenging Case

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Commentary: Loin Pain Hematuria Syndrome

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