Persistent Left Flank Pain & Blood in Urine Despite Normal Scans

I'm 36F in the UK, looking for advice regarding long-term left-sided flank and urinary symptoms that have been ongoing for around 4 years, following kidney stone obstruction and ureteric stent placement. I've seen multiple urologists and gynaecologists who have checked for stones/bladder function but have not found any issues. I've asked GPT to summarise my symptoms and history rather than give you an essay, please let me know if there's any other information needed. # Background * Had an obstructed left kidney approx. 4 years ago due to a 5mm × 7mm stone. * Underwent surgery for ureteric stent placement as the stone was close to the kidney. * Experienced severe symptoms with the stent (significant pain and heavy haematuria). * Stent remained in place for approx. 3 months. * Underwent second surgery for stent removal; stone could not be found and was presumed to have passed. * Was largely pain-free for around 6 months afterwards. # Endometriosis History * Diagnosed with endometriosis roughly 12 years ago * Had total of 3 laparoscopy (2 involved removal, 1 was clear). * Earlier this year had the 3rd surgery. Removed endometriosis affecting both ureters and both ovaries. * Surgeon has re-reviewed images taken during surgery and can see no reason for pain from gynae aspect. # Current Symptoms (Ongoing for ~4 Years) * Chronic left flank pain, now daily. * Pain location: * Left side/flank * Front and back * From below ribs to upper pelvis * Extends towards spine and sometimes towards the abdomen/navel. * Pain character: * Deep internal pain (not muscular or superficial) * Worse with activity and prolonged standing * Worse when lying on left side * Worse with firm pressure over area * Pain radiation when bad: * Into groin * down left leg * Associated symptoms: * Nausea during flares * Sudden urinary urgency * Occasional urge incontinence * Cloudy urine often # Urine Findings * Repeated urine dipsticks over several years show: * Persistent microscopic blood * Leukocytes * Occasionally trace protein * Multiple laboratory urine cultures: **no bacterial growth from any sample over 4 years** # Investigations Performed * Multiple CT scans (including contrast-enhanced) * Kidney function imaging * Bladder emptying tests Results: * No stones * No obstruction * Normal kidney drainage and function * No structural abnormalities reported * Size of kidney and diameter of tubes is as expected # Impact * Pain is now daily and limits activity. * Worse on physically active days. * Affects sleep and quality of life. * Feels progressive rather than improving. # Specialist Input So Far * Seen multiple urologists. * Advised that this may be “post-stent pain” and discharged. * No further investigation offered. * Told to "Just take pain relief each morning" # Concerns / Questions Given the combination of: * Chronic left-sided flank pain * Persistent microscopic haematuria * Normal standard imaging * Urinary urgency * History of ureteric obstruction and stenting * Ureteric endometriosis surgery I am concerned about possible causes such as: * Renal vein compression (e.g. Nutcracker syndrome) * Chronic ureteric irritation/scarring * Loin pain haematuria syndrome * Nerve-related pain * Bladder pain syndrome * Pelvic floor dysfunction I am seeking advice on: 1. Whether further investigation such as Doppler ultrasound, CT/MR angiography, venography, or specialist pelvic imaging be appropriate? 2. Which specialty referral (nephrology, vascular surgery, interventional radiology, pelvic pain/endometriosis specialist) might be most appropriate? 3. What further investigations or pathways might be appropriate in a case like this. The conditions I've listed are the closest matches I've found as a desperate non-medical person trying to get answers for why its getting worse and I understand they may not be right. Any guidance would be greatly appreciated.