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The Management of a Patient with an Acute Stone Problem

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Urolithiasis

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Abstract

Objectives: Pain management is a critical component of high-quality patient care. Renal colic (RC) is the most bothersome presentation of urolithiasis. In this chapter, we aim to present different management modalities involved in care of patients presented with RC resulting from urolithiasis. In addition guidelines for treatment are provided with critical review of the most recent advances in this field.

Materials and Methods: Database of PubMed and the Cochrane Database were searched through March 2011 without time limit. The following keywords were used: renal pain, renal colic, management, nonsteroidal anti-inflammatory drugs, opioids, alpha blockers, renal obstruction, and medical expulsive therapy. A total of 1,021 publications were retrieved. Articles of evidence-based levels of I and II were included together with publication of level III that contain large number of patients.

Results: RC is the ultimate result of obstruction of the ureter or renal collecting system. It represents one of the most frequent presentations in the emergency room (ER). Most of randomized controlled trials (RCT) have documented the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) as pharmacological agent of choice in initial management of RC. Diclofenac sodium is recommended to reduce the recurrent episodes. Opioids can be used as a second line; recent studies reported better efficacy when combined with NSAIDs without added adverse effects, while alpha blockers and calcium channel blockers are recommended for medical expulsive therapy (MET). Tamsulosin is the most studied agent with proven safety and efficacy in many RCT. Combination protocols between alpha blockers and corticosteroids might provide better results. In patients with obstructed kidneys, drainage with nephrostomy tubes or stenting should be attempted first before definitive intervention.

Conclusions: The current trends recommended NSAIDs for pain relief and alpha blockers for MET. Combination protocols are gaining more acceptance; however, dose standardization is warranted.

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Authors and Affiliations

  1. Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Ahmed S. El-Hefnawy M.D., Ahmed Abed M.D., M.S. & Ahmed A. Shokeir M.D., Ph.D., FEBU

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  1. Ahmed S. El-Hefnawy M.D.
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  2. Ahmed Abed M.D., M.S.
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  3. Ahmed A. Shokeir M.D., Ph.D., FEBU
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Correspondence to Ahmed A. Shokeir M.D., Ph.D., FEBU .

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Editors and Affiliations

  1. Department of Surgery Section of Urology, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

    Jamsheer J. Talati

  2. Karolinska Institutet, Solnavägen 1, Solna, Stockholm, 171 77, Sweden

    Hans-Goran Tiselius

  3. , Syracuse University, Crouse Hospital, 1226 East Water Street, New York, 13210, New York, USA

    David M. Albala

  4. , Department of Urology, Tongji Hospital, 1095 Jiefang Avenue, Wuhan, 430030, China, People's Republic

    ZHANGQUN YE

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El-Hefnawy, A.S., Abed, A., Shokeir, A.A. (2012). The Management of a Patient with an Acute Stone Problem. In: Talati, J., Tiselius, HG., Albala, D., YE, Z. (eds) Urolithiasis. Springer, London. https://doi.org/10.1007/978-1-4471-4387-1_44

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