Early experience of intra‐ureteric capsaicin infusion in loin pain haematuria syndrome

Abstract

Objectives To evaluate early results of the intra-ureteric instillation of capsaicin for the treatment of loin pain haematuria syndrome (LPHS). Patients and methods Ten patients with LPHS were treated using intra-ureteric capsaicin instillation. A solution of capsaicin was infused into the affected ureter through an embolectomy catheter, under anaesthesia. The success of the treatment was assessed using patient questionnaires and the quantitative reduction in the patients' analgesic requirements measured. Results During a mean follow-up of 6 months, six of the 10 patients had short-to medium-term symptomatic relief after one or more treatments; four had no relief from their symptoms. One patient had a mucosal ulceration in the bladder after extravasation of the capsaicin solution. Two patients subsequently underwent simple nephrectomy for symptomatic nonfunctioning kidneys. Conclusion These results are consistent with other preliminary reports of the ef®cacy of capsaicin treatment in LPHS and such treatment therefore has a de®nite therapeutic role in this dif®cult condition. We are uncertain if the treatment contributed to the deterioration of the excised kidneys. This early experience suggests a need for careful consideration when contemplating this treatment, with attention directed to both the initial diagnosis and possibly the technique of capsaicin/instillation. We include a protocol to follow when preparing patients for capsaicin treatment.

Loin Pain and Haematuria Syndrome (LPHS) Linked to Symptomatic Nephroptosis (SN) and Revealing Pedicle Stretch Causing Neuro-Ischaemia Using the New IVU 7 Sign

“…Loin pain hematuria syndrome was reported in 19675 while Dietl's crisis is known for centuries. Organic reno-vascular complications demonstrated on conventional arteriography of SN [11,12] and LPHS [5][6][7][8] are of advanced cases. The demonstrable link of SN with LPHS, other ischemic complications of infarction and atrophy "auto-nephrectomy" and the most elusive "autonephropexy" and "sympathetic nephroplegia" are reported here.…”

“…The underlying SN though well known [3] was disparaged [4] and LPHS though well documented, its existence may be doubted [5] and both are extremely problematic to manage [5][6][7][8].…”

The outcome of renal denervation for managing loin pain haematuria syndrome

“…Medical therapy with nifedipine and/or antiplatelet drugs has been ineffective [3,19] and the mainstay of current medical management is analgesia, generally provided by a specialized pain unit [20]. The intra‐ureteric instillation of capsaicin has been reported to have a 60% short‐term pain ‘cure’ rate in a small series; unfortunately there was major loss of renal function in 20% of the patients treated [21,22]. Renal vein venography was not used in the two patients with unilateral left‐sided LPHS, as their examination and ultrasonography findings were not suggestive of the rare ‘nutcracker syndrome’, in which the left renal vein is compressed between the aorta and superior mesenteric artery because of an abnormal branching of the superior mesenteric artery from the aorta [23–25].…”

Clinical and safety outcomes of laparoscopic nephrectomy with renal autotransplantation for the loin pain‐hematuria syndrome: a 14‐year longitudinal cohort study

“…The only notable physical exam finding for this condition is costovertebral angle tenderness. Patients with LPHS have normal renal function and no evidence of infection, trauma, or renal insufficiency (5)(6)(7)(8)(9)(10).…”