Renal colic: Also known as renal and ureteral colic, it is caused by an acute partial obstruction of the smooth muscle spasm of the renal pelvis and ureter or the lumen of the tube due to some etiology. Renal colic is a common urological emergency and requires urgent treatment.
Etiology of renal colic.
1.Stones (most common): ureteral stones, kidney stones
2, blood clots leading to acute obstruction of the upper urinary tract (tumors, vascular malformations, trauma, etc.)
3, nephritis, renal cysts, etc.
4.Infection
5.Other
Characteristics of renal colic: the nature of pain may be different depending on the location of the stone in the ureter
Mid-stage stones: sudden onset of severe pain, radiating from the abdomen to the lower abdomen;
Lower segment stones: inguinal, medial thigh, testicular or labial radiation;
Internal wall stones: suprapubic with bladder irritation (urinary frequency, urgency) of variable duration.
Renal colic is often accompanied by nausea and vomiting, profuse sweating, pallor, and tossing and turning, which can lead to shock in severe cases; hematuria.
Renal colic needs to be differentiated from the following diseases.
1, pancreatitis, cholecystitis, etc.
2, intestinal obstruction, ovarian torsion, appendicitis, etc.
3, renal vascular lesions, such as acute renal artery infarction
Auxiliary examination of renal colic
1, urine routine: positive red blood cells.
2.Ultrasound, disadvantage: middle ureteral stones may not be detected.
3, intravenous pyelogram (because renal colic can lead to transient renal failure, stone induced renal colic to be performed after 2 weeks)
4.CT: It can detect all stones in the urinary tract larger than 3mm.
Treatment of renal colic
1.Drug antispasmodic and analgesic treatment
(1) non-steroidal analgesic and anti-inflammatory drugs: diclofenac sodium and indomethacin as representatives, moderate analgesia, preferred.
(2) Opioid analgesics: generally need to be used together with atropine, 654-2 and other antispasmodic drugs.
(3) Antispasmodics.
①M-type cholinergic receptor blockers, with atropine sulfate and 654-2;
(2) Progesterone;
③Calcium blockers, such as nifedipine;
④α-blockers, which are effective in lower ureteral stones;
⑤ m-triamcinol: it can act directly on smooth muscle of gastrointestinal tract and genitourinary tract, and is a pure smooth muscle antispasmodic of pro-muscle non-atropine non-poppy bases.
2.Antibacterial therapy
3.Acupuncture therapy: Kidney Yu, Sanyinjiao, etc.
Conservative treatment: In case of renal colic caused by ureteral stones, if the stones are <6mm, smooth and without ureteral stenosis below the stones, the treatment can be conservatively observed. Specific measures: drink more water, apply painkillers to relieve pain, antispasmodic to dilate the ureter, and appropriate exercise to promote stone discharge.
Remember: 2 weeks of conservative treatment, regardless of whether there are stones discharged or not, it is necessary to review the situation to know whether there are residual stones and fluid accumulation.
Surgical treatment of renal colic
Surgical treatment measures should be considered when the pain is not relieved by medication or when the stone is larger than 6mm in diameter. These include.
(1) Extracorporeal shock wave lithotripsy, which treats ESWL as an emergency management measure. Not only can renal colic be controlled by lithotripsy, but obstruction can also be rapidly relieved.
(2) Intraureteral stent placement, which can also be used in conjunction with ESWL treatment.
(3)Transureteral lithotripsy for stone extraction.
(4) Percutaneous nephrostomy for drainage, especially for cases of renal colic with stone obstruction combined with severe infection.