Wesley A. Mayer, MD, presented “Recurrent Flank Pain: Strategies for the Successful Workup and Management of a Frustrating Clinical Conundrum” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.
How to cite: Mayer, Wesley A.. “Recurrent Flank Pain: Strategies for the Successful Workup and Management of a Frustrating Clinical Conundrum” September 14, 2018. Accessed Nov 2024. https://dev.grandroundsinurology.com/the-bottom-line-practical-application-of-clinical-trial-data-to-advanced-renal-cell-carcinoma/
Recurrent Flank Pain: Strategies for the Successful Workup and Management of a Frustrating Clinical Conundrum – Summary:
Wesley A. Mayer, MD, presents a framework for diagnosis and treatment of chronic flank pain, identifying common and uncommon causes. He discusses papillary calcifications, Loin Pain Hematuria Syndrome, polycystic kidney disease, and treatment approaches such as renal denervation and renal autotransplant.
Abstract:
Chronic flank pain can be a frustrating clinical entity both for patients and urologists. Most patients presenting with flank pain have one of many common and identifiable etiologies, such as ureteral obstruction, infection, or cancer. However, choosing an approach for a patient with severe chronic flank pain without an obvious etiology on imaging can be challenging.
If the patient has small calcifications on CT scan, these could be the result of papillary calcifications, which, for example, could be from medullary nephrocalcinosis or medullary sponge kidney. These calcifications could also be due to Randall’s plaques, or small caliceal stones. Though traditionally, one may think these calcifications wouldn’t be the source of significant pain, data does support laser papillotomy of papillary calcifications and/or the removal of small calyceal stones.
For patients with polycystic kidney disease, one can use a stepwise approach of increasing treatment invasiveness. Ultimately, clinicians may need to utilize therapies like nerve blocks, renal denervation, cyst decortication, and even nephrectomy in these cases.
This presentation reviews Loin Pain Hematuria Syndrome, including the diagnostic and therapeutic framework. Additionally, the discussion covers renal autotransplant and methods to predict success. Finally, an algorithm is proposed for treating this difficult patient population.
About Innovations in Urologic Practice
Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Mayer presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.
ABOUT THE AUTHOR
Dr. Mayer is an Associate Professor of Medicine at Baylor College of Medicine in Houston, Texas. He specializes in advanced minimally invasive surgical treatments for urologic diseases, including robotic, laparoscopic (including single-site), endourologic, and percutaneous surgery. He has a special interest in kidney cancer, kidney stones, upper urinary tract reconstruction, adrenal masses, and transplant urology. Dr. Mayer graduated from Baylor College of Medicine with the highest honors. He completed his internship in general surgery and his urology residency at the University of Pennsylvania. He was fellowship-trained in minimally invasive urology by Baylor College of Medicine’s Scott Department of Urology.
Dr. Mayer has published research on robotic partial nephrectomy, single-site donor nephrectomy, and treatment of kidney stones. Dr. Mayer is currently Baylor College of Medicine’s Urology Residency Program Director, and education is a major focus of his. His education initiatives have been presented at national meetings. Dr. Mayer has been recognized for his outstanding teaching and education efforts with the prestigious Norton Rose Fulbright Faculty Excellence Award for Teaching and Evaluation as well as the Norton Rose Fulbright Faculty Excellence Award for Educational Leadership. He has also been selected as a “Top Urologist in Houston, TX” by The Leading Physicians of the World, as well as a “Top Doctor 2019” by Houstonia Magazine.
