Indomethacin as Prophylaxis Against Recurrent Ureteral Colic

Abstract

In a prospective, randomized study, the prophylactic effect of indomethacin (150 mg daily) in regard to recurrence of ureteral colic was investigated in 78 patients. Severe recurrent attacks were experienced in 78 patients. Severe recurrent attacks were experienced by 4 of 37 patients in the test group and by 16 of the 41 controls without indomethacin. The mean duration of recurrent pain including the severe attacks was 5.6 +/- 1.1 hour/patient/week in the test group and 12.5 +/- 2.9 in the control group. Passage of stone within 7 days was not influenced by indomethacin (22/37 and 25/41 cases). Indomethacin administration for 7 days after an acute attack of ureteral colic thus reduced the frequency of severe attacks and the total duration of recurrent pain, without influencing the stone passage.

Oral Diclofenac in the Prophylactic Treatment of Recurrent Renal Colic

“…This is in contrast to the study of Holmlund [2] in which there was a significantly higher passage rate within the first 2 days in colic patients with stones <4 mm treated with oxyphenbutazone versus pla cebo. Our results agree, however, with other studies [7,8,12, 19].…”

“…The inhibitory effect from PGSI on any post-traumatic tissue damage is dependent on and most effective when administered in an early stage of the inflammatory pro cess [7], This is in accordance with the progressively declining effect over the 7 days of treatment shown in our study, and the fact that many stones have been expelled within this period.…”

“…Baseline characteristics of 41 patients treated profylactic with diclofenac and 39 with placebo stones within 7 days was not influenced by indomethacin; however, there was a significant prophylactic effect against recurrent ureteral colic [7], also confirmed in one other study [8]. It is thus possible that a 1-week treatment with an oral PGSI following an initial acute parenteral treatment may prevent new colic episodes and/or reduce the pain intensity.…”

“…A highly statistically and clinically significant effect, clearly superior to that of placebo, was demon strated. Our 50% reduction in frequency of new colic episodes can only be compared indirectly with other trials, as they have been carried out with indomethacin administered orally and/or in suppository [7,8] or have been performed following extracorporeal shockwave li thotripsy (ESWL) [12], In the placebo-controlled study of indomethacin by Grenabo and Holmlund [7] only the number of severe recurrences of renal colic requiring readmission to a hospital were reported, with 6 attacks in 37 indomethacin-treated patients and 29 attacks in 41 placebo-treated patients. In one other study with indo methacin versus placebo after ESWL, the effect has been evaluated in terms of reduced need for additional analgesic treatment [3], The results are in accordance with or superior to the reduced need for rescue medica tion as found in our study.…”

The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

“…This has been shown to significantly reduce further admissions to hospital by 28–57% (Table 2) [20,21,22]. …”