Role of Sexual Intercourse after Shockwave Lithotripsy for Distal Ureteral Stones: A Randomized Controlled Trial.

PURPOSE: To explore whether sexual intercourse is beneficial to the clinical outcome of SWL for ureteral calculi of 7-15 mm in the distal ureter. MATERIALS AND METHODS: Between March 2016 and January 2017, 225 patents with a stone (7-15 mm) in distal ureter were randomly divided into three groups after SWL: Group 1 was asked to have sexual intercourse at least three times a week, Group 2 was administered tamsulosin 0.4 mg/d and Group 3 was received standard therapy alone and served as the controls. Stone free rate, time to stone expulsion, pain score at admission, number of hospital visits for pain and steinstrasse were recorded in 2 weeks. RESULTS: 70 patients in Group 1, 71 patients in Group 2 and 68 patients in Group 3 were enrolled to the study. At the end of the first week and the second week, the stone free rates for Group 1 (68.6%, 80.0%) and Group 2 (69.0%, 81.7%) were approximately the same, but were significantly higher than Group 3 (50.0%, 63.2%) (P = .031, P = .022). The VAS scores of Groups 1 and 2 were slightly higher than those of Group 3 (P = .233). The number of patients in Group 3 who visited the emergency room for pain was significantly higher than in the other two groups (P = .015). At the end of the second week, the incidence of steinstrasse in Groups 1 and 2 was significantly lower (2.9%, 2.8% vs 11.8%) (P = .034). CONCLUSION: At least three sexual intercourses per week after SWL can effectively improve the stone free rate, reduce the formation of steinstrasse and relieve renal colic. It provides a choice for urologists in the SWL treatment of lower ureteral calculi.

Ammi Visnaga L., a Potential Medicinal Plant: A Review.

Ammi visnaga L. (Visnaga daucoides Gaertn., Family Apiaceae), also known as Khella Baldi or toothpick weed, is an annual or biennial herb indigenous to the Mediterranean region of North Africa, Asia, and Europe. The plant is known to have been used in traditional medicine a long time ago. Nowadays, it is used in modern medicine to treat many aliments such as renal colic and coronary insufficiency, and is used as an antioxidant, antifungal, and antibacterial, with a larvicidal effect on mosquito larvae. Peer-reviewed studies show that these pharmacological activities are due its valuable chemical constituents that include mainly essential oil, polyphenolic compounds including flavonoids, as well as γ-pyrones, represented mainly by khellin and visnagin. Its essential oil is reported to have antiviral, antibacterial, and larvicidal effects, while its flavonoid content is responsible for its antioxidant activity. Its γ-pyrone content has a powerful effect on facilitating the passage of kidney stones and relieving renal colic, in addition to having a relaxant effect on smooth muscle including that of the coronary arteries. The current review represents the progress in research on A. visnaga in terms of either its chemistry or biological activities. This review represents scientific support material for the use of the plant by the pharmaceutical industry.

Comparison of intravenous lidocaine/ketorolac combination to either analgesic alone for suspected renal colic pain in the ED.

STUDY OBJECTIVE: To compare analgesic efficacy and safety of intravenous lidocaine and ketorolac combination to each analgesic alone for ED patients with suspected renal colic. METHODS: We conducted a randomized, double-blind trial comparing analgesic efficacy of a combination of intravenous lidocaine (1.5 mg/kg) and ketorolac (30 mg), to ketorolac (30 mg), and to lidocaine (1.5 mg/kg) in patients aged 18-64 presenting to the ED with suspected renal colic. Primary outcome included difference in pain scores between the groups at 30 min. Secondary outcomes included a comparative reduction in pain scores in each group from baseline to 30 and 60 min as well as rates of adverse events and need for rescue analgesia at 30 and 60 min. RESULTS: We enrolled 150 subjects (50 per group). The difference in mean pain scores at 30 min between Lidocaine and Lidocaine/Ketorolac groups was -2.89 (95% CI: -4.39 to -1.39); between Ketorolac and Lidocaine/Ketorolac group was -0.92 (95% CI: -2.44 to 0.61); and between Ketorolac and Lidocaine was -1.98 (95% CI: -3.69 to -0.27). A comparative percentage of subjects in each group required rescue analgesia at 30 and 60 min. No clinically concerning changes in vital signs were observed. No serious adverse events occurred in either group. Commonly reported adverse effects were dizziness, nausea, and headache. CONCLUSION: The administration of intravenous lidocaine/ketorolac combination to ED patients with suspected renal colic results in better analgesia in comparison to lidocaine alone but provides no analgesic advantages over ketorolac alone. Clinicaltrials.gov Registration: NCT02902770.

Evaluation of the clinical significance of sonographic perinephric fluid in patients with renal colic.

OBJECTIVE: To evaluate the significance of sonographic perinephric fluid collection on the emergent management of patients with acute urinary stone obstruction. METHODS: We conducted a prospective study with retrospective analysis. Since January 2016 through July 2017, patients admitted to our tertiary hospital's emergency department (ED) with suspected symptomatic urinary stones underwent ultrasound evaluation. Images were prospectively interpreted by experienced radiologist who analyzed each case for the following imaging features: hydronephrosis, perinephric fluid and urethral stone identification. The presence and measurements of perinephric fluid were re-evaluated by second radiologist who was blinded for the first reader's measurements. Retrospective analysis was conducted to evaluate for an association between perinephric fluid collection and the following outcome variables: need for analgesics, the number of doses of analgesics and the amount of morphine (mg) in the ED, elevation of creatinine levels, hospitalization and need for urological interventions. RESULTS: The need for analgesics, the number of doses of analgesics and the amount of morphine were significantly associated with the presence of perinephric fluid (p < 0.05). The odds ratio for the need for analgesics was 3.8 in the presence of any perinephric fluid, and 8.9 in the presence of moderate/severe perinephric fluid. No other patient outcome variables were found to be significantly associated with the presence of perinephric fluid (p > 0.05). CONCLUSIONS: This study shows a correlation between sonographic evidence of perinephric fluid and more severe pain. Therefore, an emergency physician can consider the evidence of perinephric fluid, in acute urethral stone obstruction, a predictor for more severe pain.

Pathophysiology and symptoms of renal colic in children - a case report.

Urolithiasis is a disease characterized by the presence of stones in the kidney or urinary tract. It is often detected accidentally during an ultrasound or an abdominal x-ray performed for other reasons. However, the first symptom of kidney stone disease can be severe pain called renal colic. Pain caused by a colic attack is characterized by sudden onset. In half of the cases it is associated with nausea or vomiting and can lead to hypotension and fainting. The exact location and radiation of the pain depends on the location of the stone in the urinary tract. The first most commonly performed study is abdominal ultrasound with estimation of the deposit size and evaluation of urinary tract obstruction. Alternative or complementary studies are: an abdominal x-ray where radiopaque deposits can be shown, or unenhanced helical computed tomography of the abdomen. The severity of pain depends on the individual pain threshold and on the change in hydrostatic pressure in the part of the urinary system above the obstruction. Prolonged deposition of the stone in one place causes the activation of autoregulatory mechanisms to lower the pressure of the upper urinary tract, which limits the pain. The basic treatment for renal colic is analgetic therapy. The most commonly used drugs are NSAIDs and opiates. Another important component of renal colic treatment are medications that facilitate urinary stone passage by reducing oedema or limiting urethral contractions, such as: calcium channel blockers, alpha blockers, phosphodiesterase inhibitors. Intensive hydration is not currently recommended. Patients who are unlikely to spontaneously excrete the stone are eligible for minimally invasive treatment. The risk of urolithiasis recurring is high, reaching up to 40% in 5 years and up to 50% in 10 years. However, it can be reduced by proper prevention. The paper describes the pathophysiology of pain in renal colic, the treatment methods, and the case of a boy with recurrent renal colic.

Can Ureteral Jet Flow Measurement Predict Spontaneous Passage of Distal Ureteral Stones?

OBJECTIVES: The study aimed to investigate the relationship between the spontaneous passage of distal ureteral stones and ureteral jet flow measurement. METHODS: The study included 74 patients with acute renal colic between June 2015 and June 2016, and distal ureteral stones of 10 mm or less in a non-contrast CT were comprised in a prospective study. The ureteral jet was measured by Doppler ultrasonography. At the fourth week follow-up, kidney-ureter-bladder radiography was taken and the patients who no longer had a stone were considered to have spontaneously passed it. RESULTS: The average stone size of the patients was 5.6 ± 2.0 mm. After 4 weeks of follow-up, 55 patients (74.3%) had passed the stone spontaneously whereas 19 (25.6%) had not. The patients in the former group were found to have a higher peak flow velocity of ureteral jet on the stone side than those in the latter group. In regression analysis ureteral jet on the stone side was independently associated with spontaneous passage (p = 0.027). For the spontaneous passage, a ureteral jet flow peak velocity above 15.25 cm/s had an 85.4% sensitivity and 63.1% specificity. CONCLUSIONS: Measurement of the ureteral jet flow peak velocity can be beneficial in predicting the potential spontaneous passage of distal ureteral stones.

Renal colic, where is it headed? An observational study.

AIM: In the last thirty years, the treatment for renal and ureteral calculi has undergone profound variations. The objective of this study has been to evaluate the existence of parameters which can affect the spontaneous expulsion of a symptomatic ureteral stone in a reasonably brief period of time and to identify whether certain parameters such as sex, age, the location and dimension of the stone, the presence of dilation in the urinary tract together with the administered therapy, can be used for a correct clinical management of the patient. METHODS: In a period of 9 months, 486 cases of renal colic were registered at emergency department. RESULTS: The cases of renal colic due to ureteral calculus were 188 (38.7%). The patients' charts, complete of all data and therefore, valid for this research, resulted to be 120 (64%). In the presence of a symptomatic ureteral stone, the correct approach must first of all, focalize on the dimension of the calculus itself; less importance instead, is given to the location, as reported in other studies, the presence of hydroureteronephrosis, sex and the side. CONCLUSION: In the cases when the pain symptoms cannot be solved by means of the administration of analgesics, it is then reasonable to take into consideration an immediate endourological treatment. If the pain symptoms are promptly solved, an attentive wait of 4 weeks should be considered reasonable in order to allow spontaneous expulsion of the calculus.

Efficacy and safety of parecoxib/phloroglucinol combination therapy versus parecoxib monotherapy for acute renal colic: a randomized, double-blind clinical trial.

To investigate whether the addition of phloroglucinol to parecoxib could improve the efficacy in patients with acute renal colic. Patients of acute renal colic were randomly allocated to receive intravenous Parecoxib 40 mg plus placebo or Parecoxib 40 mg plus phloroglucinol 80 mg, respectively. Pain intensity was recorded using a visual analog scale (VAS) before drug administration and 5, 15, 30, 60, and 120 min after treatment start. The primary outcome was the mean pain intensity difference (PID) at each checkpoint and the effectiveness of drugs (≥ 50 % decrease in VAS score at the end checkpoint). The need for rescue analgesics and the incidence of adverse effects were considered as secondary outcome of the study. Among 236 patients enrolled in the study, 119 patients received intravenous parecoxib plus placebo and 114 patients received intravenous parecoxib plus phloroglucinol, the remaining 3 patients given up treatment. Baseline demographics were similar between two groups. There are significant differences in the PID at 15 and 30 min between two groups (P15 min = 0.011, P30 min = 0.013). Rescue analgesics were required by 17 patients (14.3 %) receiving parecoxib, 7 patients (6.1 %) receiving parecoxib plus phloroglucinol (P = 0.041). There were no differences in PID at other checkpoints between two groups, as well as in the incidence of adverse events and the drug effectiveness. Parecoxib in combination with phloroglucinol for acute renal colic has a faster action, also reduces the demand of rescue analgesics.

Ectopia renal cruzada / Crossed renal ectopiac

OBJETIVO: Aportación de dos casos de ectopia renal cruzada derecha sin fusión diagnosticada en pacientes varones de alrededor de 30 años que acuden a urgencias con sintomatología de cólico renal. MÉTODO: Presentamos los caso de dos varones que acuden al servicio de urgencias por dolor en fosa lumbar de tipo cólico. Después de realizar varias pruebas analíticas y de imagen, se descubre finalmente con la urografía intravenosa, una ectopia renal cruzada. RESULTADOS/CONCLUSIÓN: La ectopia renal cruzada derecha sin fusión es una anomalía congénita poco frecuente con una mayor incidencia en hombres. Lo más común es encontrar una ectopia renal cruzada con fusión del riñón ortotópico o en el caso que no haya fusión, que éste se encuentre en posición inferior al riñón normal, a diferencia del caso presentado. Ésta malformación no suele ir acompañada de otras alteraciones congénitas. La mayoría de casos se resuelven espontáneamente y no precisan de tratamiento quirúrgico intercurrente

OBJECTIVE: To report two cases of right crossed non-fused renal ectopia diagnosed in male patients about 30 years of age who arrived to emergency centres with symptoms of renal colic. METHODS: We report two cases of male patients who arrived to an emergency centre complaining of colic lumbar pain. Crossed renal ectopia was finally revealed by means of intravenous urogram after several analytical and imaging examinations. RESULTS/CONCLUSION: Right crossed non-fused renal ectopia is an uncommon congenital anomaly with a higher incidence in males. It is much more common to find a crossed fused renal ectopia of the orthotopic kidney. In contrast, if there is no fusion it may be located on the lower portion of the normal kidney, which is not the case in this instance. This malformation is not usually accompanied by other congenital anomalies. Most of cases are spontaneously solved and they do not require an intercurrent surgical intervention

Enfrentamiento del cólico renal en urgencia / Confrontation of renal colic in urgency

Ureteral colic as a nosologic entity, is part of a select group of pathologies that present themselves in an intense and acute form, in which the patient suffers excruciating pain and demands quick diagnosis and treatment. It’s also a common disease in our emergency service, like in other countries. The aim of the present study is to standardize and deepen the management and treatment of ureteral colic, from the perspective of the emergency medicine...

[Urogenital tuberculosis today].

In order to analyze the structure of urogenital tuberculosis, retrospective analysis of medical records of 131 patients with newly diagnosed urogenital tuberculosis observed in the Novosibirsk Regional TB Dispensary from 2009 to 2011 was performed. The renal tuberculosis is main form in the structure is urotuberculosis, detected in 75% of patients, and widespread destructive forms of the disease were diagnosed in more than half of cases. Isolated nephrotuberculosis was more often diagnosed in women--56.8%. 15.9% of patients had asymptomatic nephrotuberculosis; one-third of patients complained of pain in the lumbar region and frequent painful urination (35.2 and 39.8%, respectively); symptoms of intoxication were present in 17% of patients, renal colic--in 9.1%, and gross hematuria--in 7.9% of patients. Mycobacteriuria in isolated nephrotuberculosis was detected in 31.8% of cases. Acute tuberculous orchiepididymitis developed in 35.7% of patients, hemospermia was observed in 7.1% of patients, dysuria was in 35.7% of patients. The pain in the perineum, frequent painful urination (both by 31.6%), hemospermia (26.3%) were main complaints in prostate tuberculosis. Mycobacteria was detected in 10.5% of cases. It was found that urogenital tuberculosis has no pathognomonic symptoms; the most alarming manifestations include long-term dysuria, hematuria, hemospermia.

Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes.

OBJECTIVES: To evaluate the degree of pain associated with renal colic and primary dysmenorrhea using objective and subjective measurements. METHODS: In total, 60 subjects participated in this study. There were 20 subjects in the renal colic group (average age 24.45 ± 2.35 years), 20 subjects in the primary dysmenorrhea group (average age 23.75 ± 1.86 years), and 20 subjects in the control group (average age 24.20 ± 2.57 years). The serum chromogranin A (CgA) values were determined by an enzyme-linked immunosorbent assay and the mean pain score was assessed by means of a Visual Analog Scale (VAS) for each individual. RESULTS: The serum CgA level was 19.83 ± 19.61 ng/ml for the renal colic group, 13.45 ± 8.52 ng/ml for the primary dysmenorrhea group and 12.45 ± 7.76 ng/ml for the control group. The mean VAS score for pain was 7.95 ± 1.54 for the renal colic group and 7.05 ± 1.50 for the primary dysmenorrhea group. CONCLUSIONS: Primary dysmenorrheic pain is as intense as renal colic pain. Emergency room physicians should display the same degree of care and attention for the treatment of patients with primary dysmenorrhea as they do for patients with renal colic, and rapidly initiate an effective treatment for these patients.

Prospective evaluation of interobserver variability of the hydronephrosis index and the renal resistive index as sonographic examination methods for the evaluation of acute hydronephrosis.

OBJECTIVE: To confirm the reliability of assessements of the renal resistive index (RRI) and the hydronephrosis index (HI) comprising two sonographic techniques providing additional information in patients with acute renal colic. PATIENTS AND METHODS: Sonographic measurement of hydronephrosis and assessment of common clinical criteria was performed in 22 consecutive patients presenting with unilateral stone-related renal colic. RRI and HI were separately recorded by two investigators within a prospective study. Interobserver agreement and comparison of sonographic with computed tomography (CT) findings were assessed with the Cohen's kappa statistic (κ) for attributive ordinal characteristics and Spearman's rank correlation/rho (ρ) for attributive metric characteristics. RESULTS: There was a significant correlation between HI and the sonographically-evaluated grade of hydronephrosis, although not between RRI and the grade of hydronephrosis. For all procedures (RRI, HI, sonography and CT), significant differences between the symptomatic and the asymptomatic kidney were assessed. Interobserver agreement was excellent for the grade assessment of hydronephrosis by conventional sonography (κ = 0.82; P < 0.001), good to very good for HI (ρ = 0.60; P = 0.003) and acceptable to good for RRI (ρ = 0.49; P = 0.021). CONCLUSIONS: The RRI and HI methods are both easily practicable as stageless examination methods in patients presenting with stone-related renal colic, and both also reliably distinguish between obstruction and non-obstruction. Exact thresholds for both methods must still be defined based on further successive studies. Additionally, changes of values under medical expulsive therapy and correlation with the functional status of the obstructed kidney remain to be examined.

Comparison of the number of patients admitted with renal colic during various stages of peri-Ramadan month.

Ramadan fasting for Muslims means abstinence from eating, drinking, and smoking from sunrise to sunset. There are concerns whether the occurrence of renal colic increases during the month of Ramadan. In view of the importance of fasting among Muslims, the occurrence of renal colic during Ramadan fasting has been compared during the following periods: two weeks before commencement of Ramadan (stage-1), during the first two weeks (stage-2), the last two weeks (stage-3), and, two weeks after Ramadan (stage-4). This was a prospective observational study, which was carried out in patients with symptoms of renal colic who were referred to the emergency wards in two major hospitals in Iran. During the study period, 610 subjects were admitted with renal colic during the four periods of study; there were 441 males (72.3%) and 169 females (27.7%). The number of patients with renal colic was highest during the first two weeks of Ramadan in comparison with the other periods (stage-1: 157, stage-2: 195, stage-3: 139, stage-4: 119, P < 0.05]. Results from this study show that the number of admissions due to renal colic was high during the first two weeks of Ramadan. However, the number of admissions decreased during the last two weeks of Ramadan and this trend continued after Ramadan.

A comparative assessment of the clinical efficacy of intranasal desmopressin spray and diclofenac in the treatment of renal colic.

The aim of this study was to assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis. The study included 72 patients randomized into three different groups: group A received desmopressin (40 mg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale at baseline, 10, 30 min and 1 h after administering the treatments. Rescue analgesia was given at 30 min if needed. On admission, the pain level was the same in all three groups (group A 85; and group B and C 90 each). At 10 min the pain decreased minimally in all the groups but more in group B and C (group A 80 and group B and C 70 each). At 30 min pain scores were 75, 37.5 and 40 for group A, B and C, respectively, indicating that there was no significant pain relief in desmopressin group. Rescue analgesic had to be given to all patients in group A and two patients in group B and three patients in group C. Pain relief in the desmopressin only group was significantly less at 1 h even after rescue analgesia (pain scores of 27.5, 15 and 20 for group A, B and C respectively). Intranasal desmopressin is not an effective analgesic in renal colic: exerts mild analgesic effect over a period of 30 min. It does not potentiate the effect of diclofenac.

The effect of diclofenac sodium on renal function in reversible unilateral ureteric obstruction.

The objective of the study was to investigate the effect of diclofenac sodium, when administered similar to its use in clinical practice, 2 weeks following different periods of complete reversible unilateral ureteric obstruction in the rat using accurate indicators of renal function. Male Wistar rats underwent reversible left ureteric obstruction for 2 days [D2-untreated (n = 8) and D2-DS (n = 8) groups] and 5 days [D5-untreated (n = 7) and D5-DS (n = 7) groups]. D2-DS and D5-DS received intramuscular diclofenac sodium (3 mg/kg per day) during the time of obstruction, whereas D2-untreated and D5-untreated groups did not receive any treatment. The renal functions of both kidneys were studied 2 weeks following the reversal. The basal heart rate and mean arterial blood pressure were similar in D2-untreated and D2-DS and in D5-untreated and D5-DS groups. In the D2-untreated group, the GFR and RBF of the left obstructed kidney were 76 and 72% that of the right non-obstructed kidney [0.99 ± 0.06 vs. 1.30 ± 0.08 (P < 0.05) and 4.25 ± 0.33 vs. 5.92 ± 0.61 (P < 0.05), respectively]. The urine volume and urinary and fractional sodium excretion were not significantly different from the right kidney. Similar response was obtained in the D2-DS group. In the D5-untreated group, the GFR and RBF of the left kidney was 66 and 62% that of the right kidney (0.80 ± 0.12 vs. 1.21 ± 0.6, P < 0.05 and 3.79 ± 0.32 vs. 6.16 ± 0.59, P < 0.05; respectively). The tubular functions of both kidneys were similar. In the D5-DS group, there was no difference in GFR or RBF between both kidneys (1.02 ± 0.08 vs. 1.12 ± 0.3, P = 0.24 and 5.10 ± 1.25 vs. 6.46 ± 1.11, P = 0.44, respectively). Similarly, there was no difference in the tubular functions. Treatment with diclofenac sodium during a relatively long period of reversible unilateral ureteric obstruction, similar to its use in the management of ureteric colic, appears to ameliorate the alterations in the hemodynamic glomerular functions at least 2 weeks following the reversal of obstruction.

Comparison of intranasal desmopressin and intramuscular tramadol versus pethidine in patients with renal colic.

PURPOSE: To study the safety and efficacy of intranasal desmopressin and intramuscular tramadol versus pethidine for treatment of renal colic. MATERIALS AND METHODS: A total of 90 adult patients who presented with renal colic to the emergency wards were recruited in this study. The patients were randomly assigned to receive 100 mg intramuscular tramadol, 40µ g intranasal desmopressin, or 40µ g intranasal desmopressin plus 100 mg intramuscular tramadol. The severity of the pain was assessed using Visual Analogue Scale. RESULTS: The studied patients consisted of 49 men and 41 women with the mean age of 35.20 ± 13.26 years (range, 16 to 82 years). There was no statistically significant difference regarding the mean age (F [2, 89] = 2.98, P = .056) and gender differences (X2 = 3.3, df = 2, P = .19) in three groups. There was also no statistically significant difference considering pain relief in 3 studied groups (P = .2). CONCLUSION: We concluded that narcotics such as pethidine cannot be replaced by tramadol in patients with renal colic, but tramadol, desmopressin, or both in combination can reduce pethidine requirement.