Left Lower Abdominal Pain: Urological Insights and Concerns

Q: Left Lower Abdominal Pain: Urological Insights and Concerns

Hello： <br>1. <br>If there is a tumor in the ureter (meaning it has not yet caused any obstruction), would the tumor itself be painful? --> It should not be.<br>2. <br>If I continue to worry about issues with the ureter, are there other tests I can undergo? I asked my doctor, and

There is a dull pain in the lower left abdomen?

Hello Dr.
Du, I recently underwent a series of tests at the hospital due to hematuria (CT scan, IVP, urine cytology, etc.), and fortunately, no obvious lesions were found.
I have previously asked you some questions on this platform, and you provided detailed answers, thank you! However, one doctor mentioned during the review of my CT scan that there was a small segment of my left ureter that appeared narrower, suggesting that the ureter might have been contracting at the time the image was taken.
Upon my inquiry, the doctor stated that while a tumor could not be completely ruled out, the likelihood was low.
He recommended a follow-up in three months, which I did not pay much attention to at the time.

Recently, I have been experiencing a dull pain in my left lower abdomen, especially noticeable when sitting or bending over, which increases pressure on my abdomen.
I visited a urologist for an X-ray and underwent an IVP, but no stones were found obstructing the ureter.
I also had an ultrasound with a gastroenterologist, who suggested that it might be due to fecal impaction in the colon and prescribed some enzymes to aid in bowel movements.
After having a bowel movement, the dull pain did somewhat alleviate, but the sensation persists intermittently, sometimes strong and sometimes mild.
This has made me recall the earlier concerns about my ureter.
I would like to ask you the following questions:
1.
If a tumor is present in the ureter without causing obstruction, would the tumor itself cause pain?
2.
If I continue to worry about the ureter issue, are there other tests that can be performed? I asked my doctor about a flexible ureteroscopy for stone removal, but that is a surgical procedure, expensive, and not covered by insurance.
Are there any simple "tests" that are covered by insurance?
3.
In one of my urine cytology reports, it stated: "Few single urothelial cells with reactive change (mild unclear hyperchromasia), fungal spores and bacteria seen in a granular background." The doctor indicated that the results were normal, but since this report did not clearly state that no malignant cells were found, and given my recent left lower abdominal pain, I would like to confirm with you whether this finding can indeed be considered benign.
I appreciate your time in addressing my questions, thank you!

hshikuang, 40~49 year old female. Ask Date: 2023/10/11

Dr. Du Shixi reply Urology

Hello:
1.
If there is a tumor in the ureter (meaning it has not yet caused any obstruction), would the tumor itself be painful? --> It should not be.
2.
If I continue to worry about issues with the ureter, are there other tests I can undergo? I asked my doctor, and he mentioned performing a flexible ureteroscopy for stone removal, but that is a type of surgery, which is expensive and not covered by insurance.
I would like to know if there are any simple "tests" that are covered by insurance? --> Imaging studies such as Intravenous Pyelogram (IVP) or CT scans can be done, but they can only provide reference information.
3.
In one of my urine cytology reports, it stated, "Few single urothelial cells with reactive change (mild unclear hyperchromasia), fungal spores and bacteria seen in a granular background." The doctor said the results were normal, but unlike the other two reports, it did not clearly state that no malignancy was found.
--> Generally, if there are abnormal cells, it will be noted.
If you are still concerned, you can return for a follow-up discussion with your physician.
Wishing you good health.

Reply Date: 2023/10/11

More Info

Understanding left lower abdominal pain can be complex, especially when considering the potential urological implications. Based on your detailed description, it seems you have undergone a thorough evaluation for your symptoms, including imaging studies and urine tests. Here’s a breakdown of your concerns and some insights into the possible underlying issues.

1. Pain from Ureteral Tumors: If a tumor were to develop in the ureter, it might not cause pain until it grows large enough to obstruct urine flow or irritate surrounding tissues. Early-stage tumors can be asymptomatic, but as they progress, they may lead to pain due to pressure effects or obstruction. However, the absence of significant findings in your imaging studies, such as CT scans and IVP, suggests that a significant obstructive mass is unlikely at this time.

2. Further Investigations: If you are concerned about the ureteral issue, there are non-invasive tests that can be performed. A follow-up ultrasound or a CT scan with contrast can provide more detailed information about the ureters and surrounding structures. Additionally, a retrograde pyelogram, which involves injecting contrast dye into the ureters, can help visualize any abnormalities without the need for invasive procedures. Discuss these options with your urologist to see if they are appropriate for your situation.

3. Urine Cytology Results: The phrase "Few single urothelial cells with reactive change (mild unclear hyperchromasia), fungal spores and bacteria seen in a granular background" indicates some atypical cells but does not necessarily imply malignancy. Reactive changes can occur due to inflammation or infection, which may explain the presence of bacteria and fungal spores. It’s important to correlate these findings with your clinical symptoms and other test results. If your doctor has interpreted this as normal, it is likely because there were no definitive malignant cells identified. However, if you have ongoing concerns, it may be worth discussing the possibility of repeating the cytology test or considering a cystoscopy for direct visualization of the bladder and urethra.

4. Management of Symptoms: Given that your symptoms have been alleviated somewhat with bowel movements, it’s possible that gastrointestinal issues, such as constipation or irritable bowel syndrome, could be contributing to your abdominal discomfort. It’s essential to maintain a healthy diet rich in fiber, stay hydrated, and consider over-the-counter laxatives if necessary. If your symptoms persist, a gastroenterologist may provide additional insights into managing your gastrointestinal health.

5. Psychological Factors: Anxiety and stress can exacerbate physical symptoms, including abdominal pain. If you find yourself preoccupied with your health concerns, it may be beneficial to speak with a mental health professional. They can help you develop coping strategies to manage anxiety, which may, in turn, alleviate some of your physical symptoms.

In conclusion, while your concerns about the ureter and potential tumors are valid, the current evidence from your tests does not strongly support a significant urological issue at this time. Continuing to monitor your symptoms, maintaining open communication with your healthcare providers, and considering both physical and psychological aspects of your health will be crucial in managing your condition effectively. If your symptoms change or worsen, do not hesitate to seek further evaluation.

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