Tips for the treatment of acute renal colic (ureteral calculi)

  With the improvement of living standards, the incidence of urinary stones is increasing. The typical symptom of urinary stones is acute renal colic, which is mostly caused by the obstruction of the urinary tract after the stones fall into the ureter from the kidney. Urinary stones affect the human body mainly in the following two ways: one is obstruction, after obstruction causes fluid in the kidney, ureteral expansion, tissue tension increases leading to pain, which is the cause of renal colic, generally speaking, this pain is very intense; the other is infection, stones in the body easily lead to urinary tract infection, causing fever, urinary frequency, urinary urgency, urinary pain and other symptoms.  For the treatment of acute renal colic, it is simply seven words: antispasmodic, analgesic, anti-infective.  The human ureter has three physiological strictures, and stones tend to stay stuck in these three locations during their descent, thus causing obstruction. Generally speaking, small stones, about 5 or 6 mm, can be discharged by themselves, and there may be pain during the process. Therefore, these activities should be performed in between painful periods.  In patients with acute renal colic, the diagnosis can be made by routine tests, most commonly: 1) ultrasound of the urinary system. ultrasound can visualize hydronephrosis and dilatation of the ureter; 2) abdominal plain film. An abdominal plain film can clarify the specific part of the stone, but there are some negative stones that cannot be seen.  For larger stones, or patients with symptomatic treatment but still no significant pain relief and recurrent attacks, extracorporeal shock wave lithotripsy can be performed, which is relatively safe and the effect of lithotripsy is good. However, extracorporeal lithotripsy is not a panacea. Repeated lithotripsy in the ureter is not recommended because the energy of ultrasound will cause some damage to the ureter when lithotripsy is performed. Ureteroscopy is recommended if external lithotripsy is not effective.  The biggest problem with ureteroscopy is that the stones return to the kidney and cause incomplete treatment. In fact, ureteroscopy also carries certain risks, as the energy of local lithotripsy can escape and cause ureteral damage, resulting in secondary ureteral stenosis. Therefore, intraoperative lithotripsy in the same location for a long time is not recommended and should be performed after lithotripsy for a period of time and after pushing the stones away.  One last point about stone prevention. Clinically, many patients ask this question after treatment, how they need to pay attention to their diet in the future. Of course, if available, it is better to take a specimen for stone composition analysis after stone removal and then adjust the diet according to the results. However, in general, there are two types of stones, one is uric acid stone and the other is oxalate stone. The former may be a high purine diet, eating more meat; the latter is more common in vegetarians. Therefore, in general, it is recommended to have a balanced diet. In addition, drinking more water, exercising properly and regular review can also help a lot to prevent stone recurrence.