Until I was presented with my first case in 1990, I, too, had never knowingly seen a case of loin pain-hematuria syndrome nor had such a case been discussed at university rounds. However, loin pain-hematuria syndrome obviously exists, although it represents only a very small fraction in individuals presenting with flank pain. Autotransplantation is used as a last resort and only after symptoms have been present for some years. Approximately 30% of patients in one series[1] had spontaneous resolution of their symptoms over a mean period of 3.5 years. Whereas relief of pain is thought to be the result of denervation, in-situ denervation by pedicle stripping does not appear to be of benefit. Would orthotopic autotransplantation help? Perhaps, but there may be benefit in moving the kidney to a new location, partly from a psychological perspective and possibly from the effect of reinnervation. As Taguchi pointed out, the decision to perform this procedure is made as a last resort, the alternative for these patients being nephrectomy.
Ernest W. Ramsey, MD, FRCSC
Department of Surgery (Urology)
University of Manitoba
Winnipeg, Man.