Dealing with the pain of renal colic

Zabihi, Nasim; Teichman, Joel M.H.

doi:10.1016/s0140-6736(01)05668-9

Cited by 20 publications

(13 citation statements)

References 10 publications

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“…However, NSAIDs may further diminish renal function in patients with an obstruction, particularly those with preexisting renal impairment. 16,17 Nonetheless, data indicate that in typical doses ketorolac -which is commonly used for colic -poses little risk of renal failure and does not increase the risk of surgical bleeding (Table 1). 18 Although randomized, double-blind trials are lacking, ketorolac and diclofenac appear to be at least as effective as narcotics.…”

Section: Pain and Nauseamentioning

confidence: 99%

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Acute Renal Colic from Ureteral Calculus

Teichman¹

2004

N Engl J Med

332

180

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The new england journal of medicine n engl j med 350;7 www.nejm.org february 12, 2004 684 This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 39-year-old man reports an eight-hour history of colicky pain in the right lower quadrant radiating to the tip of his penis. He had previously had a kidney stone, which passed spontaneously. Physical examination shows that he is in distress, is afebrile, and has tenderness of the right costovertebral angle and lower quadrant. Urinalysis shows microhematuria. Helical computed tomography (CT) of the abdomen and pelvis shows a 6-mm calculus of the right distal ureter and mild hydroureteronephrosis. How should this patient be treated?Up to 12 percent of the population will have a urinary stone during their lifetime, and recurrence rates approach 50 percent. 1 In the United States, white men have the highest incidence of stones, followed in order by white women, black women, and black men. 2,3 Fifty-five percent of those with recurrent stones have a family history of urolithiasis, 4 and having such a history increases the risk of stones by a factor of three. 5The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin. As the stone descends in the ureter, the pain may localize in the abdominal area overlying the stone and radiate to the gonad. Peritoneal signs are absent. As the stone approaches the ureterovesical junction (Fig. 1), lower-quadrant pain radiating to the tip of the urethra, urinary urgency and frequency, and dysuria are characteristic, mimicking the symptoms of bacterial cystitis. Physical examination typically shows a patient who is often writhing in distress, trying to find a comfortable position. Tenderness of the costovertebral angle or lower quadrant may be present. Gross or microscopic hematuria occurs in approximately 90 percent of patients; however, the absence of hematuria does not preclude the presence of stones. 6 Owing to the shared splanchnic innervation of the renal capsule and intestines, hydronephrosis and distention of the renal capsule may produce nausea and vomiting. Thus, acute renal colic may mimic acute abdominal or pelvic conditions. diagnosisThe best imaging study to confirm the diagnosis of a urinary stone in a patient with acute flank pain is unenhanced, helical CT of the abdomen and pelvis (Fig. 1). 7 In a prospective trial of 106 adults with acute flank pain, all patients underwent both unenhanced helical CT and intravenous urography (the previous gold standard), 8 and the results of each were interpreted separately and in a blinded fashion by a radiologist. Seventy-five patients received a diagnosis of ureteral stones. The sensitivity of CT was 96 percent, as compared with 87 percent for urography, and the respective specificities were 100 percent and 94 percent (P<0.001 for both compar...

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Section: Pain and Nauseamentioning

confidence: 99%

“…The new england journal of medicine 686 diuretic desmopressin, 14,17,21 although data on this approach are limited. If NSAIDs, COX-2 inhibitors, or desmopressin is used, overhydration should be avoided, since the objective of treatment is to reduce ureteral spasms.…”

Section: Pain and Nauseamentioning

confidence: 99%

Acute Renal Colic from Ureteral Calculus

Teichman¹

2004

N Engl J Med

332

180

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“…A recent report showed equal analgesic potencies of desmopressin and diclofenac in patients with acute renal colic [32]. The study underlines the need for further investigation to determine the role of opioids, NSAIDs, and desmopressin in treating renal colic [33].…”

Section: Pain Therapy For Renal Colicmentioning

confidence: 77%

Pain Management for Urological Cancer Patients in Palliative Care

Oya¹,

Koike²,

Naoki³

et al. 2013

J Palliat Care Med

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“…The effects of opioid analgesics have recently been hypothesized also to be correlated with inhibitors of adenylate cyclase. Peripherally, they act directly upon ureteral smooth muscles and increase isotonic contraction tone and length to produce ureteral spasm [10] which increases intra-ureteral pressure and constitutes an obstacle to stone progress towards elimination. Therefore, as drugs such as morphine, codeine and their derivates hamper stone elimination and have severe adverse central and peripheral side effects (narcosis, depression of respiration, constipation and vomiting), they are second-choice therapy for renal colic.…”

Section: Opioid Analgesicsmentioning

confidence: 99%

Pain Killers and Antibacterial Therapy for Kidney Colic and Stones

Porena

Guiggi²,

Balestra³

et al. 2004

Urol Int

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In 85% of patients, renal colic is caused by renal-ureteral stones with extrinsic obstructions such as pelvic, retroperitoneal or intestinal abnormalities, and intrinsic reno-ureteral obstructions, e.g. junction pathologies and malformation, accounting for only 10 and 5%, respectively. The objectives of therapy for renal colic therapy are to eliminate pain, preserve renal function and eliminate the obstruction by the excretory pathway. Many drugs can be used to relieve pain: non-steroid anti-inflammatory agents (NSAIDs), opioid analgesics, antidiuretic hormone (ADH), loco-regional anesthesia and acupuncture. Opiates are the first-choice therapy during pregnancy as no other drug is indicated because of tetragenic potential. Paracetamol (N-acetyl-p-aminophenol) is the only NSAID that is registered for pediatric use because it has none of the adverse side effects that are associated with NSAIDs. Tamsulosin, an alpha-lithic drug, has very recently been included among the drugs that are used for stone expulsion. The rationale underlying its use is that a high concentration of α-1D adrenergic receptors has been recently detected in the terminal ureter, especially in the intramural tract. Inhibition of α-1D receptor stimulation should relax smooth muscle in the intramural ureteral tract, making stone expulsion easier.

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Dealing with the pain of renal colic

Cited by 20 publications

References 10 publications

Acute Renal Colic from Ureteral Calculus

Acute Renal Colic from Ureteral Calculus

Pain Management for Urological Cancer Patients in Palliative Care

Pain Killers and Antibacterial Therapy for Kidney Colic and Stones

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