Possible Causes of Pain in the Loin

1. Renal:
   • Stone
   • Malignancy
   • Infections (pyelonephritis, perinephric abscess, etc.)
   • Polycystic kidney
   • Dietl’s crisis-A sudden attack of acute lumbar and abdominal pain accompanied by nausea and vomiting, caused by kinking of the ureter in persons with wandering kidney.
2. Extra-renal:
   • Acute pancreatitis
   • Cholecystitis
   • Appendicitis
   • Porphyria
   • Ruptured duodenal ulcer or spleen
   • Ectopic gestation

Common Urinary Problems and Their Causes

Frequency of Micturition and Nocturia

1. Bladder: Cystitis, small contracted bladder, tumors, vesicular calculus, cystocele.
2. Bladder neck: Incomplete evacuation due to enlarged prostrate or stricture of urethra, incompetent internal urethral sphincter, ectopic ureter.
3. Urethra: Urethritis, neoplasms, balanitis, stricture of urethra, pinhole meatus, phimosis.
4. Miscellaneous: Polyuria, psychogenic, pregnancy, pressure from surrounding structures.

Hesitancy and Precipitancy of Urine

1. Cerebral: Cerebrovascular accidents, cerebral tumors, head injuries, etc.
2. Urinary tract disease: Enlarged prostate, bladder neck obstruction.

Anuria or Absence of Urine

1. Renal: Glomerulonephritis, pyelonephritis, polycystic kidney, chronic renal failure, nephrotoxic drugs, SLE etc.
2. Pre-renal: Diarrhea and vomiting, burns, blood loss, hypotension, septicemia, intravascular hemolysis, etc.
3. Obstructive: Calculi in kidney or urinary tract, blockage of ureters by malignancy or crystals, retroperitoneal fibrosis, accidental ligation during surgery, etc.

Retention of Urine

1. Neurological: Spinal cord diseases (Transverse and compression myelitis), cauda equina lesions, multiple sclerosis.
2. Genito-urinary
   • Penis: Phimosis
   • Urethra: Posterior urethral valves, foreign body, stones, stricture, rupture, spasm of the sphincter, etc.
   • Prostatic enlargement
   • Bladder: Atony, tumor, stone, or compression by fibroids or retroverted uterus.
   • Following parturition
3. Drugs: Sympathomimetic agents, salbutamol, terbutaline, anti-cholinergic drugs, etc.
4. Functional

Pyuria or Pus In The Urine-What Could Be The Causes?

Normally there are no pus cells in the urine. If there is a pus in the urine it is a cause for worry. Pus in the urine could indicate one of the following causes.

Renal:

• Infective: Pyelonephritis, pyonephrosis, perianal abscess, renal tuberculosis
• Non-infective: Hypersensitivity nephritis, analgesic nephropathy, hypokalemia, nephrocalcinosis, lead poisoning, radiation nephritis

Lower urinary tract:

• Cystitis: Infective, radiation, cytotoxic drugs.
• Urethritis.

Adnexa:

• Perinephric abscess, gynecological infections