Right Flank Pain After Hematuria: Urology or Nephrology?

Hematuria followed by right flank pain?

Hello doctor, I recently went to the emergency room due to hematuria and mentioned to the doctor that I had some mild lower back pain.
However, after the doctor performed percussion, there was no significant reaction, so I was prescribed medication for three days.
I did not return for a follow-up, and it has been almost two weeks since then.
My urine output has returned to normal, but sometimes I experience some pain in the bones above the urethra, and there is a consistent pain in the lower right side of my back.
When I lie down, I also feel a bit of nausea.
The left side of my back doesn't hurt as much as the right, but I still feel some discomfort.
I'm not entirely sure if this is related to premenstrual symptoms, as I usually don't experience this level of pain before my period.
Should I see a urologist or a nephrologist?

Ms. Zhang, 20~29 year old female. Ask Date: 2016/02/12

Dr. Chen Wenming reply Urology

You should consult a urologist.

Reply Date: 2016/02/12

More Info

When experiencing right flank pain after hematuria (blood in urine), it is essential to determine whether the symptoms are related to urological issues or nephrological conditions. Given your history of hematuria and the recent onset of flank pain, it is advisable to consult a healthcare professional who specializes in either urology or nephrology.

Understanding the Symptoms
1. Hematuria: This condition can arise from various causes, including urinary tract infections (UTIs), kidney stones, trauma, or more serious conditions such as tumors. The presence of blood in the urine often indicates that there is an underlying issue that needs to be addressed.

2. Flank Pain: Pain in the flank area, particularly on the right side, can be associated with kidney issues, such as kidney stones or infections. However, it can also be related to musculoskeletal problems, especially if the pain is localized and does not radiate.

3. Other Symptoms: The additional symptoms you mentioned, such as nausea and discomfort in the lower abdomen, could indicate a more complex issue. Nausea can sometimes accompany kidney problems or may be related to gastrointestinal issues.

Urology vs. Nephrology
- Urology: This specialty focuses on the urinary tract and male reproductive system. Urologists are well-equipped to handle issues related to hematuria, urinary tract infections, and kidney stones. If your symptoms are primarily related to the urinary tract, such as pain during urination or persistent hematuria, a urologist would be the appropriate specialist to consult.

- Nephrology: This specialty deals with kidney function and diseases. If there are concerns about kidney function, such as changes in urination patterns, kidney disease, or complications from previous conditions, a nephrologist would be the right choice.

Recommendations
Given your symptoms of flank pain and previous hematuria, here are some steps to consider:
1. Consult a Urologist: Since you have experienced hematuria and are now experiencing flank pain, starting with a urologist may be beneficial. They can perform necessary imaging studies, such as an ultrasound or CT scan, to evaluate the kidneys and urinary tract for stones, tumors, or other abnormalities.

2. Monitor Symptoms: Keep track of any changes in your symptoms, including the intensity of the pain, any changes in urination, and the presence of other symptoms like fever or chills. This information will be helpful for your healthcare provider.

3. Follow-Up: If the urologist rules out urinary tract issues and your symptoms persist, a referral to a nephrologist may be warranted to assess kidney function and any underlying renal conditions.

4. Consider Other Factors: Since you mentioned that your pain may correlate with your menstrual cycle, it’s also worth considering whether the pain could be related to gynecological issues. If the urologist does not find any urinary tract issues, consulting a gynecologist might also be beneficial.

Conclusion
In summary, given your history of hematuria and current symptoms of flank pain, it is advisable to start with a urologist. They can help determine if there are any urological issues that need to be addressed. If necessary, they can refer you to a nephrologist for further evaluation of kidney function. It’s crucial to address these symptoms promptly to ensure that any underlying conditions are diagnosed and treated appropriately.

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