PAIN

Classification Pain:

Local Pain : is felt in or near the involved organ.

Referred Pain : originates in a diseased organ but is felt at some distance from tat organ.

Type of pain

Dull pain : typical renal pain and constant ache in costovertebral angle just lateral to the
sacrosinalis muscle and just below the 12th rib.

Coliky pain : typically simulated by acute obstruction (passage of stone or bllod clot in the ureter).
There is back pain from renal capsular distension combined with severe coliky pain that radiates from
the costovertebral angle down towards lower anterior abdominal quadrant, along couse of ureter.

Flank pain : felt as a dull and constant ache in the costovertebral angle just lateral to the
sacrospinalis muscle and just below the 12th rib. This pain often spreads along subcostal area towards
the umbilicus or lower abdominal quadrant.
Pain GU

Pain arising from GU tract may quite severe and usually associated with either urinary tract obstruction
or inflammation. Inflammation of the GU tract is more severe when involves the parenchyma of a GU
organ. Tumors in GU tract usually do not cause pain unless they produce obstruction or extend beyond
the primary organ to involves adjacent nerves.

Renal Pain

Pain of renal origin is usually located in the ipsilateral costovertebral angle just lateral to the
sacrospinalis muscle and beneath the 12th rib. Pain is usually caused by acute distension of renal
capsule, generally from inflammation or obstruction that may radiate across the flank anteriorly toward
the upper abdomen and umbilicus and may be referred to the testis or labium. Pain due the
inflammation is usually steady, whereas pain due to obstruction fluctuates in intensity. Thus, the pain
produced by ureteral obstruction is trypically colicky in nature and intensifies with ureteral peristalsis,
at which time the pressure in the renal pelvis rises as he ureter contracts in attempt to force urine past
the point of obstruction. Pain ofrenal may be associated with gastrointestinal symptoms because of
reflex stimulation ex; liver, pancreas, duodenum, gallbladder and colon.

Ureteral Pain

Ureteral pain usually acute and secondary obstruction. The pain result from acute distension of ureter
and by hyperperistalsis and spasm of smooth muscle of the ureter as it attempts to relieve the
obstruction, usually produced by stone or blood clot. The site of ureteral obstruction can often be
determined by te location of the referred pain. With obstruction of midureter, pain on the right side is
referred to the right lower quadrant of the abdomen(McBurneys) and thus can stimulate appendicitis;
pain on left side is referred over lower quadrant and resembles diverticulits. Pain may reffered to the
scrotum in the male or labium in te female.Lower ureteral obstruction frequently produces symptoms
of vesical irritability, including frequency, urgency, and suprapubic discomfort that may radiate along
the urethra in men to the tip of penis.
Vesical Pain

Vesical pain usually produced either by overdistension of the bladder as result of acute urinary
retension or buy inflammation. Constant suprapubic pain that is unrelated to urinary retension is
seldom of urologic origin. Inflammatory conditions of the bladder usually produse intermittent
suprapubic disdcomfort. Thus, the pain in condition such as bacterial cystitis or interstitial cystitis
usually more severe when the bladder is full and relieved at least partially voiding.

Prostatic Pain

Prostatic pain is usually secondary to inflammation with secondary edema and distension of prostatic
capsule.Pain of prostatic origin is poorly localized, and the patient may complain of lowert abdominal,
inguinal, perineal, lumbosacral, and/or rectal pain. Prostatic pain is frequently associated with irritative
uninary symptoms such as frequency and dysuria,and severe cases, marked prostatic edema may
produse ascute urinary retension.

Penile Pain

Pain in flaccid penis is usually secondary to inflammation in the bladder or urethra,with referred pin
that is experienced maxillary at urethral meatus. Penile pain may be produced by paraphimosis, a
condition in which the uncircumcised penile foreskin is trapped behind the gland penis, resulting in
venous obstructin and painful engorgement of the gland penis. Pain in the erect penis is usually due to
Peyronies disease or priapism.
Location of stone by anamnesis

Ureteropelvic stone : Severe costovertebral angle pain from capsular and pelvic distention ; acute
renal and urethral pain from hyperperistalsis of smooth muscle of calyces, pelvis, and ureter, with pain
radiating along course of ureter (and into testicle, since the nerve supply to the kidney and testis is the
same). Testis is hypersensitive.

Midureteral stone : Same as above but pain in the lower quadrant.

Low ureteral stone : Some above, withpain radiating in bladder,vulva, or scrotum.The scrotal wall
hyperesthetic .Testicular sensitivity is absent. When the stone approaches the bladder, urgency and
frequency with burning urination develop as a result of inflammation of the bladder wall around the
ureteral orifice.