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Arch Hellen Med, 28(2), March-April 2011, 166-174


Review of the data on acute renal colic and symptomatic urolithiasis

Κ. Stravodimos, T. Tokas
First Department of Urology, "Laiko" General Hospital, University of Athens, Athens, Greece

Renal colic, as a symptom, expresses the partial or complete obstruction of the excretory system of the kidney, the ureter. The pain intensity is related more to the speed of onset than to the grade of obstruction. Colic is associated imwith both environmental and inherited factors. The presentation of renal colic follows a procedure of stimulation of special neurogenic fibers, as a result of activation of specific receptors and production of chemical substances and other specific factors. Ureter obstruction is completed in three stages, during which changes in renal blood flow and ureteric pressure are observed. Possible complications of acute ureteric obstruction include decrease in the glomerular filtration rate and creation of a urinoma, but complete renal failure is very rare. Urolithiasis is the main cause of renal colic, with less usual causes being blood clots, tumors of the urinary tract, obstruction of the uretero-pelvic-junction obstruction and external ureteric obstruction by retroperitoneal masses. The clinical expression of renal colic is usually typical. Acute appendicitis, acute cholecystitis, acute diverticulitis, ectopic pregnancy, and aortic aneurysm are included in the differential diagnosis. The history of the patient and a thorough clinical examination contribute to the diagnosis. Imaging is extremely important for both diagnosis and identification of the cause of the colic, localization of the obstruction and detection of potential complications. Reliable imaging techniques are a plain X-ray film of the kidneys, ureter and bladder (KUB), combined with ultrasonography (US), intravenous urography (IVU) and unenhanced helical computed tomography (CT). Treatment is usually conservative, as most stones are small and are passed spontaneously in the urine, and consists of non-steroidal antiinflammatory agents and α1-inhibitors, and calcium channel blockers in selected cases. Indications for intervention and active stone removal are a stone diameter of >=7 mm, prolonged obstruction, persistent pain, concurrent infection, lack of response to conservative treatment, obstruction in a solitary kidney, or bilateral obstruction. The goal of active treatment is the immediate drainage of the urinary tract and management of the cause of obstruction. Drainage is achieved with the use of a percutaneous nephrostomy catheter or an internal ureteral stent (double J stent). Treatment of the cause of obstruction can be achieved with extracorporeal shock wave lithotripsy (ESWL) in the case of large stones, or endoscopic, percutaneous, laparoscopic or open surgical procedures.

Key words: Data, Nephrolithiasis, Renal colic, Symptoms, Urinary system.

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