The most common presenting symptoms of gynecologic patients are chronic lower abdominal pain and backache. These are usually, but often erroneously, interpreted by the patient as being due to abnormalities of the genital tract. This self-made diagnosis of ovarian or uterine disease too often finds concurrence in the opinion of the surgeon and repeatedly leads to unnecessary and harmful operations. Many, if not a majority, of the pains referred to the lower part of the abdomen and back are not due to genital disorders but are the results of orthopedic defects, gastrointestinal disturbances, or abnormalities of the urinary tract. For many years Hunner has been emphasizing the important relationship between urinary tract conditions and obscure pelvic symptoms. He has stressed the symptom complex of the stricture of the ureter and has repeatedly demonstrated the relief of those symptoms by appropriate treatment.
Genital disease may be simulated by ureteral stricture, stricture
BROWN PT, PENNINGTON JW. PELVIC SYMPTOMS OF URINARY TRACT ORIGIN. JAMA. 1941;116(3):189–193. doi:10.1001/jama.1941.02820030011003