Background: Loin pain hematuria syndrome (LPHS) is an uncommon condition. This is a clinical entity comprising unilateral or bilateral intractable flank and loin pain with microscopic or gross hematuria. The etiology is poorly understood, and the diagnosis is made by exclusion of urological and nephrologic conditions.The management is mainly symptomatic, aiming for pain relief with non-opioid and opioid analgesics, and interventions such as capsaicin infusion into the renal pelvis, and percutaneous regional nerve blocks to laparoscopic or open surgical procedures. The surgical procedures include renal denervation, nephrectomy, and renal auto transplantation. The condition may be intractable to many of the interventions.Case Series: We are presenting two cases which were successfully treated with spinal nerve root stimulation (SNRS) by positioning a 33 cm Standard Quadripolar electrode at T10/11/12 spinal nerve roots and a second quad electrode inserted in a retrograde fashion to the right S2-S4 region. In both cases there was a successful outcome in terms of consistent pain relief and surgery was avoided.Conclusion: SNRS may be a useful tool to control a complex pain condition such as LPHS, particularly when classical spinal cord stimulation does not tend to cover the loin area. In order to provide stimulation coverage of this area SNRS was used. With this approach one has to ensure that the electrode stays dorsally on the nerve root to provide sensory and avoid motor stimulation which could be unpleasant. Moreover, the use of multiple cathodes could prevent painful motor stimulation.
展开▼
