Ureteric stones

Acute renal colic is a common presentation to the emergency department. It is estimated that about 12% of men and 5% of women will have at least one symptomatic stone by the age of 70. Renal colic has an annual incidence 16 cases per 10,000 per year, and a lifetime incidence of 2–5%. In the year 2000, there were over 600,000 emergency room visits for urolithiasis listed as the primary diagnosis in the United States alone. In this chapter, acute pharmacologic management of patients diagnosed with ureteral stones will be outlined. The pharmacology and clinical efficacy for narcotic and non-narcotic analgesics will be reviewed. In addition, medical expulsive therapy using alpha blockers and other agents will be extensively reviewed, in order to provide a targeted approach to the pharmacologic management of patients diagnosed with acute renal colic secondary to a ureteral stone.

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Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

10.22514/sv.2020.16.0056 ◽

2020 ◽

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Soft Tissue ◽

Renal Colic ◽

Repeated Administration ◽

Pain Medication ◽

Ureteral Stones ◽

Large Size ◽

Acute Renal Colic ◽

Enhanced Computed Tomography

Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.

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