Neuropathic Pain Patterns in Patients with Ureteric Malignancies: A Clinical and Radiological Correlation

Abstract

Objective:  To identify patterns of neuropathic pain in patients with ureteric malignancies and determine their association with radiological findings.

Methods:  This prospective observational study was conducted at Lady Reading Hospital, Peshawar. A total of 188 patients with suspected or histopathologically confirmed ureteric malignancies were included. Detailed clinical assessments were performed to classify pain into localized flank pain, radiating neuropathic pain, dermatomal pain, and mixed patterns. Pain severity was measured using the Numeric Rating Scale. Radiological evaluation included contrast-enhanced CT urography or MRI to assess tumor location, ureteric obstruction, hydronephrosis, and peri-ureteric infiltration. The associations between neuropathic pain patterns and imaging findings were evaluated using the chi-square test.

Results:  Radiating neuropathic pain was observed in 32.2% of patients, while 17.8% presented with dermatomal neuropathic pain. Distal ureteric tumors were the most common, frequently associated with hydronephrosis (62.7%). A significant association was found between neuropathic pain and radiological evidence of tumor infiltration
(p = 0.001). Patients with advanced radiological features, particularly peri-ureteric invasion, were more likely to exhibit neuropathic pain characteristics.

Conclusion:  Neuropathic pain is a prominent and clinically significant symptom in patients with ureteric malignancies and is strongly associated with radiological tumor invasion. Integrating clinical pain assessment with imaging findings can improve diagnostic accuracy and guide more appropriate management strategies, ultimately enhancing patient care outcomes.

Keywords:  Ureteric malignancy, Neuropathic Pain, Urothelial Carcinoma, CT urography, Radiological Correlation