Risk of Stroke After Posterior Reversible Encephalopathy Syndrome.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) can cause short-term cerebrovascular complications, such as brain infarction and hemorrhage. We hypothesized that PRES is also associated with an increased long-term risk of stroke. METHODS: We performed a retrospective cohort study in the United States using statewide all-payer claims data from 2016 to 2018 on all admissions to nonfederal hospitals in 11 states. Adults with PRES were compared with adults with renal colic (negative control) and transient ischemic attack (TIA; positive control). Any stroke and the secondary outcomes of ischemic and hemorrhagic stroke were ascertained using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We excluded prevalent stroke. We used time-to-event statistics to calculate incidence rates and Cox proportional hazards analyses to evaluate the association between PRES and stroke, adjusting for demographics and stroke risk factors. In a sensitivity analysis, outcomes within 2 weeks of index admission were excluded. RESULTS: We identified 1606 patients with PRES, 1192 with renal colic, and 38 216 with TIA. Patients with PRES had a mean age of 56±17 years; 72% were women. Over a median follow-up of 0.9 years, the stroke incidence per 100 person-years was 6.1 (95% CI, 5.0-7.4) after PRES, 1.0 (95% CI, 0.62-1.8) after renal colic, and 9.7 (95% CI, 9.4-10.0) after TIA. After statistical adjustment for patient characteristics and risk factors, patients with PRES had an elevated risk of stroke compared with renal colic (hazard ratio [HR], 2.3 [95% CI, 1.7-3.0]), but lower risk than patients with TIA (HR, 0.67 [95% CI, 0.54-0.82]). In secondary analyses, compared with TIA, PRES was associated with hemorrhagic stroke (HR, 2.0 [95% CI, 1.4-2.9]). PRES was associated with ischemic stroke when compared with renal colic (HR, 1.9 [95% CI, 1.4-2.7]) but not when compared with TIA (HR, 0.49 [95% CI, 0.38-0.63]). Results were similar with 2-week washout. CONCLUSIONS: Patients with PRES had an elevated risk of incident stroke.

A Diagnostic Score for Reliable Confirmation of Acute Renal Colic Among Patients With Acute Abdominal Pain.

BACKGROUND/AIM: Diagnostic scores (DSs) for confirmation of acute renal colic (ARCO) have rarely been evaluated. PATIENTS AND METHODS: A cohort of 1,333 patients with acute abdominal pain (AAP) were studied, including 59 patients with confirmed ARCO. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for the diagnosis of ARCO. Meta-analytical techniques were used to detect the summary sensitivity and specificity estimates for each data set (clinical symptoms, signs and tests, as well as DS formulas). RESULTS: In hierarchical summary receiver operating characteristic analysis (HSROC), the values for area under the curve (95% confidence interval) for i) clinical symptoms ii) signs and tests, and iii) DS were 0.650 (0.612-0.688), 0.724 (0.680-0.768) and 0.962 (0.940-0.984), respectively. In HSROC analysis of the area under the curve values, differences were significant between i) and iii) (p<0.0001) and between ii) and iii) (p<0.0001). CONCLUSION: The present study is the first to provide evidence suggesting that the DS can be used for clinical confirmation of ARCO in patients with AAP, with a high diagnostic accuracy without radiological or laboratory analyses.

[Overview of ureteral stone management]. / Prise en charge de la lithiase urétérale.

Ureteral stones are a major health concern with a worldwide rising prevalence. In countries with a high standard of living, the prevalence urolithiasis is notably high with over 10%. Ureteral stones formed in the kidney and then descending the ureter commonly manifest themselves as renal colic. The treatment of ureteral stones includes conservative treatment, medical expulsion therapy, interventional stone treatment such as ureteral stenting, ureteroscopy and extracorporeal shock wave lithotripsy as well as (oral) chemolysis in selected cases. This article presents a comprehensive overview on the treatment of ureteral stones and an outlook on advancements in treatment.

La maladie lithiasique est un problème de santé majeur en augmentation. Dans les pays industrialisés, la prévalence de la maladie lithiasique est particulièrement élevée, plus de 10 %. Les lithiases sont formées dans le rein, puis elles migrent dans l'uretère où elles se manifestent couramment par des coliques néphrétiques. La prise en charge des lithiases urétérales comprend les traitements conservateur, médical expulsif, interventionnels comme la pose de stent urétéral, l'urétéroscopie ou la lithotripsie extracorporelle, ainsi que la chimiolyse orale dans certains cas. Cet article présente un résumé de la prise en charge de la lithiase urétérale ainsi que les progrès réalisés en matière de traitement.

Transversus abdominis plane block: A new method in renal colic pain management.

In recent decades, regional plane blocks via ultrasonography have become very popular in regional anesthesia and are more commonly used in pain management. The transversus abdominis plane (TAP) block is a procedure where local anesthetics are applied to block the anterior divisions of the tenth thoracic intercostal through the first lumbar nerves (T10-L1) into the anatomic space formed amidst the internal oblique and transversus abdominis muscles located in the antero-lateral part of the abdomen wall. The most important advantage of this block method is that ultrasonographic identification is easier and its complications are fewer compared with central neuroaxial or paravertebral blocks. Here, we describe three cases where pain management in renal colic was treated with the TAP block.

Comparing Intradermal Sterile Water with Intravenous Morphine in Reducing Pain in Patients with Renal Colic: A Double-Blind Randomized Clinical Trial.

OBJECTIVE: The present study was conducted to investigate the effect of intradermal administration of sterile water compared to intravenous morphine on patients with renal colic. METHODS: This double-blind, randomized clinical trial study was conducted in 2017 to compare the therapeutic effects of intradermal sterile water with those of intravenous morphine on patients with renal colic presenting to the emergency departments (ED) of Imam Khomeini and Golestan Hospitals in Ahvaz, Iran. The first group received 0.5 ml of intradermal sterile water, and the second group 0.1mg/kg of intravenous morphine plus 0.5 ml of intradermal sterile water in the most painful area or the center of the painful area in the flank. The pain severity was measured using a visual analogue scale (VAS), and the medication side-effects were recorded at the beginning of the study and minutes 15, 30,45 and 60. RESULTS: A total of 94 patients were studied in two groups. The mean severity of pain was 2.97 ± 1.51 in the sterile water group and 2.34 ± 1.89 in the morphine group at minute 30 (P=0.042), 2.58 ± 1.43 in the sterile water group and 1 ± 1.23 in the morphine group at minute 45 (P<0.001), and 1.89 ± 1.7 in the sterile water group and 0.52 ± 0.79 in the morphine group at minute 60 (P<0.001). CONCLUSION: Morphine reduces pain faster and more effectively than intradermal sterile water; nevertheless, treatment with intradermal sterile water can be used as an appropriate surrogate or adjunct therapy for pain control, particularly in special patients or in case of medication scarcity.

Seasonal Variation in the Frequency of Presentation with Acute Ureteral Colic and Its Association with Meteorologic Factors.

Introduction: A seasonal variation in the frequency of acute stone presentations has been observed in studies from the United States, Africa, and Asia. The increased incidence of acute stone presentations during periods of warm weather has been attributed to both the dehydrating effect of elevated temperatures and the vitamin D related increase in calciuria during periods of increased sunshine. The aim of this study is to establish whether the association between various meteorologic parameters and the frequency of acute stone presentations also exists in a European climate. Methods: All computed tomography kidneys, ureters and bladder scans performed by Emergency Departments within the Dublin Midland Hospital Group between June 2017 and September 2018 were identified from the national radiologic database. The date of scan in addition to stone parameters (site, size, and side) was recorded. These data were then correlated with weather recordings obtained from the Irish meteorologic office. Results: A total of 2441 patients were investigated for suspected renal colic during the study period of which 781 were confirmed to have ureteral stones. An increased frequency of acute stone presentations was observed during the summer months of both years (June, July, and August). Unexpectedly, the heat wave of summer 2018 was not associated with an increased frequency of nephrolithiasis compared with summer 2017. Conclusion: There is an increased frequency of acute nephrolithiasis during the summer months in Ireland. Health care services should be tailored to expect an increase in service needs during these periods of increased activity.

Is There Gender Discrimination in Acute Renal Colic Pain Management? A Retrospective Analysis in an Emergency Department Setting.

BACKGROUND: Pain is a widespread problem, affecting both men and women; studies have found that women in the emergency department receive analgesic medication and opioids less often compared with men. AIMS: The aim of this study was to examine the administration and management of analgesics by the medical/paramedical staff in relation to the patients' gender, and thereby to examine the extent of gender discrimination in treating pain. DESIGN: This is a single-center retrospective cohort study that included 824 patients. SETTINGS: Emergency department of tertiary hospital in Israel. PARTICIPANTS/SUBJECTS: The patients stratified by gender to compare pain treatments and waiting times between men and women in renal colic complaint. METHODS: As an acute pain model, we used renal colic with a nephrolithiasis diagnosis confirmed by imaging. We recorded pain level by Visual Analog Scale (VAS) scores and number of VAS examinations. Time intervals were calculated between admissions to different stations in the emergency department. We recorded the number of analgesic drugs administered, type of drugs prescribed, and drug class (opioids or others). RESULTS: A total of 824 patients (414 women and 410 men) participated. There were no significant differences in age, ethnicity, and laboratory findings. VAS assessments were higher in men than in women (6.43 versus 5.90, p = .001, respectively). More men than women received analgesics (68.8% versus 62.1%, p = .04, respectively) and opioids were prescribed more often for men than for women (48.3 versus 35.7%, p = .001). The number of drugs prescribed per patient was also higher in men compared with women (1.06 versus 0.93, p = .03). A significant difference was found in waiting time length from admission to medical examination between non-Jewish women and Jewish women. CONCLUSIONS: We found differences in pain management between genders, which could be interpreted as gender discrimination. Yet these differences could also be attributed to other factors not based on gender discrimination but rather on gender differences.

CT imaging history for patients presenting to the ED with renal colic--evidence from a multi-hospital database.

BACKGROUND: Patients with renal colic have a 7% chance of annual recurrence. Previous studies evaluating cumulative Abbreviations: computed tomography (CT) exposure for renal colic patients were typically from single centers. METHODS: This was an observational cohort study. Inner-city ED patients with a final diagnosis of renal colic were prospectively identified (1/10/16-10/16/16). Authors conducted structured electronic record reviews from a 6-hospital system encompassing over 192,000 annual ED visits. Categorical data analyzed by chi-square; continuous data by t-tests. Primary outcome measure was the proportion of study group patients with prior history CT abdomen/pelvis CT. RESULTS: Two hundred thirteen patients in the study group; 59% male, age 38+/- 10 years, 67% Hispanic, 62% prior stone history, flank pain (78%), dysuria (22%), UA (+) blood (75%). 60% (95% CI = 53-66%) of patients received an EDCV CT; hydronephrosis seen in 55% (95% CI = 46-63%), stone in 90%(95% CI = 83-94%). No significant differences observed in the proportion of EDCV patients who received CT with respect to: female vs. male (62% vs. 56%; p = 0.4), mean age (37+/- 9 years vs. 39+/- 11 years; p = 0.2), and Hispanic vs. non-Hispanic white (63% vs.63%; p = 0.96). Patients with a prior stone history were more likely than those with no history to receive an EDCV CT (88% vs. 16%; p < 0.001). 118 (55%; 95% CI = 49-62%) of patients had at least one prior CT, 46 (22%; 95% CI = 16-28%) had ≥3 prior CTs; 29 (14%; 95% CI = 10-19%), ≥ 10 prior CTs. Patients who did not receive an EDCV CT had a significantly higher mean prior number of CTs than those who had EDCV CT (5.1+/- 7.7 vs 2.2+/- 4.9; p < 0.001). Patients with prior stone were more likely to receive only U/S during EDCV (33% vs. 15%; p = 0.003). CONCLUSIONS: Within our EDCV cohort of renal colic patients, 55% had at least one prior CT. The mean number of prior CTs was lower for patients receiving CT on EDCV, and Ultrasound (US) alone was used more often in patients with prior stone history vs. those with no prior history.

Relief of refractory renal colic in emergency department: A novel indication for ultrasound guided erector spinae plane block.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Erector spinae plane (ESP) block involves injection of local anesthetics between erector spinae muscles and transverse process of vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. The primary factor in the great popularity of this block is easy sonographic identification of landmarks and lower complication rate compared to paravertebral or central neuroaxial blocks. These characteristics mean that it will in all probability be widely used in the future, not just for anesthetists, but also for emergency physicians. Here we first report a novel indication for ESP block in emergency department; renal colic.

Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial.

INTRODUCTION: Renal colic is a prevalent cause of abdominal pain in the emergency department. Although non-steroidal anti-inflammatory drugs and opioids are used for the treatment of renal colic, some adverse effects have been reported. Therefore, desmopressin -a synthetic analogue of vasopressin- has been proposed as another treatment choice. In the present study, indomethacin in combination with nasal desmopressin was compared with indomethacin alone in the management of renal colic. METHODS: Included in the study were 124 patients with initial diagnosis of renal colic and randomized to receive indomethacin suppository (100 mg) with either desmopressin intranasal spray (4 puffs, total dose of 40 micrograms) and or placebo intranasal spray. RESULTS: All the included patients were finally diagnosed with renal colic. There was no difference between the two groups in pain at the baseline (p = 0.4) and both treatments reduced pain successfully (p < 0.001). There was no significant difference between the two groups in pain reduction (p = 0.35). CONCLUSIONS: While there was significant pain reduction in both patients groups, pain reduction of NSAIDs (e.g. indomethacin) in renal colic, does not significantly improve when given in combination with desmopressin.

Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study.

BACKGROUND: Ureter muscles contraction movements caused pain in renal colic. Magnesium sulphate could influence the pain by reducing acetylcholine in the nerve terminals. We have aimed to evaluate the analgesic effects of magnesium sulphate on acute renal colic pain. METHOD: In this double-blind clinical trial study, the patients with renal colic pain were randomly divided into 2 groups; Group I received an intravenous infusion of 30 mg of Ketorolac and normal saline as placebo, Group II 50 mg/kg magnesium sulphate 50%/100 ml normal plus 30 mg of Ketorolac. The pain severity of patients was assessed using the visual analog scale (VAS) at baseline, and 15 and 30 min after intervention. RESULTS: Baseline pain score and demographic characteristics did not significantly different between the groups. After 30 min the pain score significantly reduced in both groups. While, at 15 and 30 min, mean pain score did not show statistically significant differences. CONCLUSION: Our findings indicated that Magnesium sulphate did not influence renal colic pain relief.

Does co-treatment with ultra-low-dose naloxone and morphine provide better analgesia in renal colic patients?

OBJECTIVE: This study attempted to evaluate the efficacy of ultra-low-dose intravenous (IV) naloxone combined with IV morphine, as compared to IV morphine alone, in terms of reducing pain and morphine-induced side effects in patients with renal colic. METHODS: In this double-blind clinical trial, 150 patients aged 34 to 60 years old who presented to the emergency department (ED) with renal colic were randomly allocated to either an intervention group that received ultra-low-dose IV naloxone combined with IV morphine or to a control group that received morphine plus a placebo. The severity of pain, sedation, and nausea were assessed and recorded for all patients at entrance to the ED (T1), then at 20 (T2), 40 (T3), 60 (T4), 120 (T5), and 180 (T6) minutes after starting treatment. The Numeric Rating Scale (NRS) was used for the assessment of pain and nausea intensities, and the Ramsay Sedation Scale (RSS) was used to assess sedation. RESULTS: A GEE model revealed that patients in the naloxone group had non-significantly reduced pain scores compared to those in the morphine group (coefficient = -0.68; 95% CI: -1.24 to -0.11, Wald X2 (1) = 5.41, p = 0.02). The sedation outcome demonstrated no statistically significant differences at T1 to T4 among patients with renal colic compared to the ones who only received morphine. At T5 and T6, 1.5% vs. 20% and 1.5% vs. 16.9% of subjects from the naloxone group versus the morphine group obtained RSS scores equal to 3, respectively (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: Compared to patients who only received IV morphine, co-treatment of ultra-low-dose naloxone with morphine could not provide better analgesia and sedation/agitation states in renal colic patients.

[Nephrocalcinosis and proximal tubulopathy in Sjögren's Syndrome.] / Nefrocalcinosis y acidosis tubular renal proximal en síndrome de Sjögren.

Primary Sjögren's syndrome is a systemic and chronic autoimmune disease. Renal involvement may occur in up to 30% of patients. The incidence of tubulopathies ranges from 2.6 to 33%. They are manifested by defects in the urine concentration and hydroelectrolyte alterations, mainly distal tubular acidosis and exceptionally proximal tubular acidosis. These disorders can be associated with nephrocalcinosis and renal lithiasis. We report the case of a patient with primary Sjögren who presented proximal renal tubular acidosis associated with recurrent renal colic due to renal lithiasis and nephrocalcinosis. We highlight the importance of diagnosing renal tubular acidosis in patients with Sjögren's syndrome that present alterations in urinary sediment and electrolyte disorders to avoid nephrocalcinosis and nephrolithiasis. Acidosis correction treatment aims to prevent the progression of the disorder and preserve renal function.

El síndrome de Sjögren primario es una enfermedad autoinmune sistémica de evolución crónica. Puede presentar compromiso renal hasta en un 30% de los pacientes.La incidencia de tubulopatías varía de 2.6 a 33%. Se manifiestan por defectos en la concentración de la orina y alteraciones hidroelectrolíticas, principalmente acidosis tubular distal y de manera excepcional acidosis tubular proximal. Estos trastornos pueden asociarse a Nefrocalcinosis y litiasis renal. Reportamos el caso de una paciente con Sjögren primario que presentó acidosis tubular renal proximal asociada a cólicos renales recurrentes por litiasis renal y nefrocalcinosis. Destacamos la importancia de diagnosticar acidosis tubular renal en pacientes con síndrome de Sjögren que presenten alteraciones en el sedimento urinario y desórdenes electrolíticos para evitar la nefrocalcinosis medular y las nefrolitiasis asociadas. La terapia para la corrección de la acidosis tiene como objetivo evitar la progresión del trastorno y preservar la función renal.

Pain management of renal colic in the emergency department with intravenous lidocaine.

OBJECTIVE: To describe our experience with intravenous lidocaine (IVL) to manage pain of renal colic origin in the emergency department (ED). METHODS: A retrospective analysis of all patients presenting with pain of renal colic origin from the periods of 2014 to 2017 by using the ED electronic medical record database (Allscripts™). RESULTS: Forty-four patients received IVL for renal colic over a three-year period. The average dose of IVL as a primary analgesic was 117.2 mg, and as a rescue was 108 mg. Administration of IVL resulted in a decrease in overall pain score by 6.3 points (numerical rating scale), by 7.4 points when IVL was used as a primary analgesic, and by 5.2 points when IVL was given as a rescue. There were no documented adverse effects. CONCLUSION: Intravenous lidocaine has a potential of being used for patients presenting to the ED with a pain of renal colic origin as a primary analgesic or as a rescue. Although promising, this therapy will need to be studied in prospective randomized fashion and larger patients' population with underlying cardiac disease before it can be recommended for broad use in the ED.

Prospective Evaluation of Predictive Parameters for Urinary Tract Infection in Patients with Acute Renal Colic.

BACKGROUND: Acute renal colic (ARC) is an emergency that can mostly be treated conservatively, but can be life threatening in combination with urinary tract infection (UTI). Assessment for infection includes white blood cell (WBC) count and C-reactive protein (CRP), but these parameters are often unspecifically elevated and might lead to antibiotic over-therapy. In times of increasing antibiotic resistance, however, unnecessary antibiotic therapy should be avoided. OBJECTIVES: The goal of the study was to investigate the prevalence of UTI proven by urine culture (UC) in patients with ARC and to identify predictive factors in the emergency setting. PATIENTS AND METHODS: We prospectively enrolled 200 consecutive patients with ARC and evaluated blood test results, urinalysis, UC, symptoms suspicious for UTI, and time between symptom onset and admission, as well as body temperature. Logistic regression analyses were performed to identify predictive factors. RESULTS: There were 196 patients eligible for statistical analysis. UTI proven by positive UC was detected in 26 patients (13%). On multivariate logistic regression analysis, suspicious urinalysis (positive nitrite or bacteria > 20/high-power field [hpf] or WBC > 20/hpf), patient age ≥ 54 years and CRP ≥ 1.5 mg/dL (fivefold increase) were significant predictors for the presence of UTI. Neither elevated WBC count nor typical UTI symptoms were associated with UTI. CONCLUSIONS: Based on our results, a routine antibiotic prophylaxis in patients with ARC does not seem to be appropriate. Patient age and CRP can help to decide if antibiotic treatment might be indicated, even in case of a not clearly suspicious urinalysis.

Point-of-Care Ultrasound Identifies Urinoma Complicating Simple Renal Colic: A Case Series and Literature Review.

BACKGROUND: Renal colic is a frequently encountered diagnosis among emergency department patients. Point-of-care (POC) ultrasound has taken on an increasingly important role in the diagnostic strategy of this disease, as it has been shown to be an effective modality for diagnosis and for guiding management. The primary pathology that the emergency physician will evaluate for in cases of suspected renal colic is hydronephrosis, which is a dilatation of the renal pelvis and calyces resulting from a distal obstruction such as a ureteral stone. However, other significant findings can be seen, one of which is the extravasation of urine around the kidney secondary to a forniceal, or calyceal, rupture. CASE SERIES: We present three cases of unanticipated perinephric fluid collections identified initially on POC ultrasound in cases of suspected simple renal colic. Concomitant hydronephrosis was also seen in each of these cases. Why Should an Emergency Physician Be Aware of This? While the utilization of POC ultrasound in cases of suspected renal colic increases, we should be prepared to encounter and identify perinephric fluid collections in our evaluations. Although the ideal management of these cases is not completely defined from the current literature, we benefit from knowing how to identify these on POC ultrasound, understanding the underlying pathophysiology, and appreciating the possibility of complications that may arise.

Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial.

BACKGROUND: The combination of morphine with low doses of ketamine (MK) has been utilized in the Emergency Department (ED) compared with morphine and placebo (MP) for the treatment of acute pain in few studies. The purpose of this study was to compare the effect of MP with MK for the treatment of severe pain with renal colic of patients who had been referred to the ED. METHODS: This study is a double blind randomized clinical trial on patients with severe renal colic pain who were referred to the ED. Patients were enrolled with pain severity of at least 6 of the 10 visual analogue scales (VAS). Patients were divided into two groups: Morphine 0.1mg/kg and placebo (MP group) and morphine 0.1mg/kg and ketamine 0.15mg/kg (MK group). Pain of patients was studied in 10, 30, 60, 90, and 120min after injection. RESULTS: Totally, 106 patients were enrolled in study groups. Assessment of the average pain during 120min at 10 and 30min after the start in the drug, MK group was significantly lower than the MP group (p=0.019 and p=0.003 respectively). CONCLUSION: Given that combinations of morphine with low doses of ketamine in patients with renal colic pain causes more pain and morphine consumption reduction then this combination is suggested as an alternative treatment that could be utilized in patients with renal colic.

What is the best analgesic option for patients presenting with renal colic to the emergency department? Protocol for a systematic review and meta-analysis.

INTRODUCTION: Patients with renal colic present to the emergency department in excruciating pain. There is variability in practice regarding the choice of initial analgesic to be used in renal colic. The aim of this article is to outline the protocol for review of the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol use in renal colic pain management. METHODS AND ANALYSIS: This is the protocol for a systematic review, comparing efficacy of NSAIDs, opioids and paracetamol in renal colic studied under randomised controlled trial (RCT) design. This protocol reporting is based on the PRISMA-P recommendations (PRISMA-P-checklist). We will conduct a comprehensive literature search for both peer-reviewed and grey literature published until 18 December 2016. Using a predefined search strategy, MEDLINE, Embase and Cochrane Central Register of Controlled Trials will be searched. Additional searches will include WHO International Clinical Trials Registry Platform, abstract list of relevant major conferences and the reference lists of relevant publications. Two authors will independently screen and identify the studies to be included. The RCT comparing NSAIDs versus opioids or paracetamol will be included in the review, if the age of participants in the study was >16 years and they presented with moderate to severe renal colic. Any disagreement between the screening authors will be resolved through discussion and reaching consensus; if not, a third reviewer will arbitrate. Quantitative data from homogeneous studies will be pooled in the meta-analysis using RevMan V.5.3 software. The findings of this review will be presented according to the guidelines in the Cochrane Handbook of Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. ETHICS AND DISSEMINATION: Formal ethics approval is not required, as primary data will not be collected. We plan to publish the result of this review in a peer-reviewed journal.

Relationship Between Ureteral Jet Flow, Visual Analogue Scale, and Ureteral Stone Size.

OBJECTIVE: To contribute to the diagnosis and treatment of ureteral stones by investigating the relationship between the ureteral jet flow measurements of patients with ureteral stones and the size of the stones and the patients' pain scores. MATERIALS AND METHODS: The sample consisted of patients who presented acute renal colic between December 2014 and 2015 and from a noncontrast computed tomography were found to have a urinary stone. The ureteral jet flow velocities were determined using Doppler ultrasonography. The patients were all assessed in terms of stone size, localization and area, anteroposterior pelvis (AP) diameter, and visual analogue scale (VAS) scores. RESULTS: A total of 102 patients were included in the study. As the VAS score decreased, the peak jet flow velocity on the stone side increased, whereas the flow velocity on the other side, AP diameter, and stone area were reduced (P < .05). As the stone size increased, the peak jet flow velocity was reduced and the AP diameter increased significantly (P < .05). Ureteral jet flow was not observed in 17 patients on the stone side. A statistically significant difference was found between these patients and the remaining patients in terms of all parameters (P < .05). CONCLUSION: For patients, in whom the peak flow velocity of ureteral jet is low and with a severe level of pain or the peak flow velocity of ureteral jet cannot be measured, there is a low possibility of spontaneous passage and a high possibility of a large stone, and therefore the treatment should be started immediately.