Via practica 6/2010

Renal colic in general practice

Renal colic is emergency situation and therefore every general practitioner should know basic diagnostic and treatment principles. Most frequent etiology is ureteric stone. Urological history, examination, urine analysis, blood tests, kidney ultrasound and plain abdominal X-Ray film often allow a diagnosis to be reached and management to be planned. Intravenous urogram and/or computed tomography are helpful in selected cases. Management of the acute episode is essentially conservative in most cases. Pain should be relieved by adequate regular doses of analgesic drugs (first line treatment: diclofenac, ibuprofen, ketoprofen, paracetamol; second line treatment: tramadol, hydromorphin). On the conservative regime 60 % of all stones pass spontaneously, the others need intervention (extracorporeal shockwave lithotripsy, ureteroscopic extraction or surgery). If obstructive pyelonephritis develops urgent relief of obstruction is indicated (stone removal, retrograde cystoscopic insertion of double-J ureteric stent or percutaneous nephrostomy).

Keywords: renal colic, general practice, ureteric stone, non-steroid antiflogistics, spasmolytics