Silent Lesions of the Upper Urinary Tract
A certain percentage of lesions of the upper urinary tract do not produce any outstanding subjective symptoms which obviously pertain to the kidney and the ureter. Because of this fact we designate them “silent lesions,” and because of the absence of symptoms referable to the urinary tract an incorrect diagnosis is often made with unfortunate and sometimes fatal results. It must not be understood that many of these lesions do not give any symptoms, but the symptoms are not referable to the organ diseased.
Prominent among these lesions are kidney tumors, kidney stones and often ureteral calculi as well, but hydronephrosis, inflammatory conditions, certain anomalies of the urinary tract and other conditions should also be included. Pyonephritis, pyelonephrosis, pyelitis, hydronephrosis, nephroptosis, and ureteral stricture also may fail to produce any characteristic symptoms referable to the seat of the lesion. The symptoms of any of these conditions may apparently relate to the gastro-intestinal tract, to the spine, to certain orthopedic conditions or in women, in particular, to the genital organs.
It is apparent, then, that the location of the discomfort as described by the patient is not always a dependable guide and that the answer to the question: “What is your complaint?” may be most misleading. Of course a physical examination will often readily disclose the real lesion, but too often a complete examination is not made or the attention of the physician may be directed entirely to the area of referred discomfort or pain and the treatment is directed accordingly.