Ureteric bupivicaine infusion for loin pain haematuria syndrome

Abstract

INTRODUCTION Loin pain haematuria syndrome is a common problem with complications including opiate dependence. Morbidity treatments include intra-ureteric capsaicin infusion, nephrectomy, autotransplantation and nephrolysis. We explored the use of flexible cystoscopic infusion of intra-ureteric bupivicaine. PATIENTS AND METHODS Patients presenting with chronic loin pain underwent urological and nephrological evaluation. Bupivicaine (0.5%, 20 ml) was infused via an intra-ureteric catheter under flexible cystoscopic guidance. Repeat infusions were offered if indicated. RESULTS Sixteen of 17 patients with 1-year follow-up responded and were satisfied. Twelve of these required repeat infusions (mean, 2.9 infusions). The procedures were well tolerated by all patients without adverse effects. CONCLUSIONS Intra-ureteric bupivicaine infusion has a place in the management of patients with chronic renal pain. It offers a minimally invasive alternative to other treatments. This procedure warrants further investigation within a randomised, controlled trial setting.

Bilateral Renal Autotransplantation May Be an Effective and Definitive Treatment in Case of Loin Pain Haematuria Syndrome

“…Advocates of non-surgical management have failed to show persistent success in pain relief by their non-specific management (pain medication, antidepressants, ureteral capsaicin infusion, ureteric bupivicaine infusion) [4][5][6] . Moreover, frequent secondary effects associated with these therapies ranged from mild to severe, with cases of nephrectomy after capsaicin injection reported or subsequent dependency on opiates.…”

Renal impairment and analgesia: From effectiveness to adverse effects

“…A case report was reported where, upon failure to relieve pain through these methods, intraspinal morphine was effective for the purpose (Prager, DeSalles, Wilkinson, Jacobs, & Csete, 1995). Intraureteric bupivacaine also provides a long-term potential for the analgesic treatment of LPHS (Ahmed, Acher, & Deane, 2010), whereas an intrarenal administration of capsaicin was seen to have transitory effectiveness in addition ALIZADEH AND AGHSAIE FARD | 17207 to complications (Uzoh, Kumar, & Timoney, 2009). However, surgical methods are mostly found to be curative in this case (Zubair, Salameh, Erickson, & Prieto, 2016).…”

Loin Pain Haematuria Syndrome - A Narrative Review of Pain Management Strategies

“…Intraureteric infusion of various substances via the flexible cystoscopy route with palliative and curative analgesic intent has been reported by numerous authors, albeit on lesser numbers of patients. In one of the more promising studies over the last few years, Ahmed et al [ 14 ] demonstrated favourable potential for bupivacaine (0.5%) in the long-term treatment of loin pain. Endoscopic administration of 20 ml of 0.5% bupivacaine solution at a day procedure unit was reported in 17 patients with loin pain, among whom 12 had been diagnosed with LPHS.…”