Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial.

BACKGROUND: Multidrug pain control can be beneficial in relieving pain and limiting narcotic use in renal colic. The purpose of this study was to evaluate the effects of adding dexamethasone to ketorolac on pain control in acute renal colic. METHODS: One hundred twenty patients with renal colic were randomized into comparison and intervention groups to investigate the effect of 8 mg of dexamethasone with 30 mg ketorolac administered immediately after the patient's admission. The primary outcome was pain intensity based on the visual analog scale (VAS), which was assessed at the baseline and after 30 and 60 min of drugs treatment. Also, grade of vomiting and narcotic or antiemetic requirement were measured at the baseline and after the 60-min intervention. RESULTS: A total of 120 patients were included in the final analysis, with 60 patients (50%) randomized to the comparison group (just ketorolac) and 60 (50%) randomized to the intervention group (ketorolac + dexamethasone). There were no significant demographic differences between groups (P > 0.05 for all). Differences in VAS scores were significantly lower in the intervention group after 30 min of drug administration (P = 0.009, compared with the control). However, there was not a significant difference in the median VAS score between groups at the baseline and end of the study (P > 0.05). At the end of the study, the percent of patients who need to narcotics (35% vs. 58%, P = 0.01) and/or antiemetic (12% vs. 28%, P = 0.022) were significantly lower in the intervention group compared with the controls. CONCLUSIONS: In comparison with the patients who just received ketorolac, adding dexamethasone provided improved pain control after 30 min of therapy. Furthermore, it decreased opioid requirements and decreased an antiemetic need at the end of the study. Dexamethasone should be considered an important multimodal adjunct for controlling pain and nausea in renal colic.

Urodynamic findings in young men with chronic lower urinary tract symptoms.

AIM: To assess frequency of urodynamic abnormalities in young men with chronic lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We assessed 456 men (18-40 years old) with chronic LUTS. Those with the history of urogenital malignancies, neurological disease, urethral stricture or trauma, acute UTI, congenital urological disease, and diabetes mellitus were excluded. Patients were classified by special urodynamic diagnosis. RESULTS: Mean patient age was 25.8 ± 5.9 years old and the mean symptom duration was 12.3 ± 3.2 months. Urodynamic studies showed bladder neck dysfunction in 96 of cases (21%), dysfunctional voiding in 69 (15.1%), detrusor overactivity in 62 (13.6%), small cystometric capacity in 49 (10.7%), and acontractile detrusor in 48 (10.5%), underactive detrusor in 11 (2.4%), low compliance in 18 (3.9%), detrusor overactivity plus acontractile detrusor in 6 (1.3%), low compliance plus small cystometric capacity in 5 (1.0%), detrusor overactivity plus small cystometric capacity together with low compliance in 4 (0.8%), low compliance plus Underactive detrusor in 3 (0.6%) and normal urodynamics in 85 (18.6%). Mean Q(max) in patients with bladder neck dysfunction, dysfunctional voiding, underactive detrusor, acontractile detrusor, underactive detrusor plus low compliance, and acontractile detrusor plus detrusor overactivity were lower than those of the other groups. Mean postvoid residues in patients with underactive detrusor, and underactive detrusor plus low compliance, were higher than those in the remaining groups. Positive four-glass test in patient with normal urodynamic was greater than those in the remaining groups. CONCLUSION: A few clinical symptoms or noninvasive tests were useful in young men with chronic LUTS; hence, urodynamics are advised to make the correct diagnosis in this regard.

Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for the Treatment of Renal Stones in a Horseshoe Kidney.

The objective of this case report is to highlight treatment by LAT-PCNL in a patient with horseshoe kidney. A 51-year-man with hematuria presented to the emergency department with moderate abdominal pain starting 7 hrs ago. He did not report a history of previous urological disease. Renal stone and horseshoe kidney malformation were diagnosed based on the plain abdominal film, intravenous urogram (IVU), non-contrast computed tomography (CT-IVU), and ultrasound findings. Due to the larger stone bulk and renal malformation, it was not possible to perform extracorporeal shock wave lithotripsy (ESWL) monotherapy or ESWL sandwich therapy. Moreover, since percutaneous nephrolithotomy (PCNL) had some challenges and limitations due to high skin-to-stone distance, special anatomy, dispersion stones, and possible consequent internal organs injuries, we performed LAT-PCNL on our patient. We did not observe any perioperative complication. Postoperative control abdominal x-ray revealed only a medium ureteral stone that was extracted while removing the Double-J stent a month later. The patient was discharged on the third postoperative day with normal laboratory values. At 3-month follow-up, the patient was stone-free with normal renal function and renal ultrasonography. Laparoscopy-assisted transperitoneal PCNL seems to be a safe and minimally invasive technique that can be used as an alternative approach in the management of renal stones in special cases of horseshoe kidneys.