Management of renal colic

Abstract

Urinary stone disease is increasingly prevalent, with a lifetime risk of about 12% in men and 6% in women. 1 Age of onset of a first stone episode for men rises from their 20s and peaks at age 40-60 years, with an incidence of three cases per 1000 population per year. Women appear to peak a little younger in their late 20s. The male to female ratio is narrowing, with one study showing a reduction from 1.7:1 to 1.3:1 over a five year period. 2 Presentation varies according to geographical and seasonal factors, with higher incidences in warmer climates and during the summer months. 3This review includes the latest information from meta-analyses, systematic reviews, randomised trials, current guidelines, and other peer reviewed evidence to provide a background on presentation, investigation, and medical and surgical management of patients with renal colic. What are urinary stones?Urinary stones are formed by the aggregation of crystals with a non-crystalline protein (matrix) component. 3 These crystals clump together to form a stone and then move when they reach a certain size and pass down the ureter, frequently causing colic symptoms. Eighty per cent of stones contain calcium, most commonly in the form of calcium oxalate (60%). Calcium phosphate accounts for 20% of stones, with uric acid forming approximately 7%, 3 although this uric acid proportion may rise in obese patients. Another 7% are infection stones containing magnesium ammonium phosphate. Bladder stones usually have a different cause, often as a result of bladder outflow obstruction.

Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial)

“…7 Ureteric colic is one of the most common reasons for people to seek emergency health care, with an annual incidence of around 30 out of 100,000 in high-resource parts of the world. 8 In the UK, 83,000 people required emergency care for ureteric colic in 2009, 9 and NHS England health episode statistics data for 2012-13 showed 31,000 hospital admissions with a 1-day median stay and a NHS tariff cost of £19.3M. 10 In the USA, there were 600,000 emergency room visits in 2000 at an estimated health-care cost of US$490M.…”

A Fatal Diagnosis in Emergency Department: Renal Colic

“…Taşın neden olduğu obstrüksiyon üreter, pelvikalisiyel sistem ve renal kapsülde distansiyona neden olur, ardından bu yapıların spazmı ile ağrı ortaya çıkar. 8 Genellikle renal kolik ağrısı ani, künt flank ağrısı olarak başlar. Aort diseksiyonu, renal kolik ayırıcı tanısında yer alan ölümcül bir hastalıktır.…”

Management of Pain in the Emergency Department

“…Examples of such pain for which NSAIDs are known to be particularly useful include renal colic [111][112][113] and menstrual cramps [114,115]. NSAIDs are far less likely to be effective for pain that is noninflammatory (e.g., neuropathic pain, or pain from leg swelling related to chronic edema).…”

“…They tend to have few "nuisance" side effects such as nausea or allergy. Furthermore, use of NSAIDs has been shown to have useful opioid-sparing effects in a variety of clinical situations ranging from sickle cell vaso-occlusive crisis to renal colic [111,[116][117][118]. Some of the more serious or controversial side effects of ED NSAID use deserve attention in prospective trials.…”