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What Causes Persistent Right-sided Flank Pain After A Hysterectomy?

Posted on Fri, 7 Jul 2017

Question: I'm 6 weeks s/p total hysterectomy. Starting week 2 post op I began having a lot of pelvic and right flank pain. After a work up my ct results came back stating below. I'm scheduled with urology next week after getting a nuc med scan on Monday to further evaluate. Could this be the cause of the pain? Something I should be concerned about? What are treatment options? Just hoping to get prepared prior to my appointment. Ct results: There is tortuosity at the RIGHT ureteropelvic junction with slight prominence of the RIGHT renal pelvis. The kidneys are otherwise unremarkable without significant hydronephrosis. No ureteral abnormality identified, although the RIGHT mid and distal ureter is not opacified.

Answered by Dr. Dr. P. T. Patil (19 hours later)

Brief Answer:
Pain could be due to obstruction to urine flow from the kidney into the ureter.

Detailed Answer:
Hello,
Thanks for the query.

You have undergone surgery of Hysterectomy 6 weeks back and getting severe pain in Rt loin.

The pain that you have is mostly due to obstruction to urine flow from Rt kidney down into ureter which has been revealed as a tortuosity of the ureter at PUJ level. The cause of obstruction could be intra operative injury to ureter or may be congenital.

The further study (DTPA) scan will reveal the status of kidney function which will help to decide the further management.

I think putting a D J stent in ureter should help to deobstruct the system and relieve pain and restore the kidney function.

Hope I have answered your query, please feel free to ask if you have more questions, I shall be happy to help you.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. P. T. Patil (41 minutes later)

thank you for your response! I've been taking zofran tid regularly because the nausea associated is so bad. I have also been taking Percocet prn as otc analgesics are not helping at all. I have random fevers, but nothing regular. the pain is gradually worsening. thankfully I see the urologist on Wednesday. is there a point of concern prior to that I should be aware of in order to get attention prior if needed? I'm hoping there will be an easy and effective resolution. I know it was mentioned that it could just be a stone obstructing things even though one was not seen. are the obstruction and tortuosity two separate issues that would each need dealt with?

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Treatment will depend upon the results of test

Detailed Answer:
Hello
Thanks for follow up .

One thing that is certain that the severe pain is due to obstruction to flow of urine which could be either stone or accidental injury to ureter during surgery or post operative kinking of ureter due to adhesion .The primary target in such situation is to establish the cause of obstruction.and save the kidney from damage ..

Tortuousity of the ureter is secondary to obstruction and get resolved after the system is deobstructed .(Putting stent _.

Since there is mild hydronephrosis hopefully the problem can be resolved with putting a stent in ureter which is a simple endoscopic procedure .

Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Remy Koshy