Renal colic is a common urological emergency and is divided into pharmacological and surgical treatment.
I. Drug treatment.
1, non-steroidal analgesic and anti-inflammatory drugs.
Commonly used drugs are diclofenac sodium (fotarine) and indomethacin (anti-inflammatory pain), which can inhibit the biosynthesis of prostaglandins in the body, reduce the sensitivity of nociceptive nerve endings to pain-causing substances, and have a moderate analgesic effect. Diclofenac sodium is also able to reduce ureteral edema and reduce the rate of pain recurrence, commonly used as 50 mg intramuscular injection. Diclofenac can also act directly on the ureter, and is administered as 25mg orally, or as a 100mg anal anal suppository. Diclofenac sodium will affect the glomerular filtration rate in patients with renal dysfunction, but will not have an effect on those with normal renal function.
2. Opioid analgesics.
Opioid receptor agonists, acting on the opioid receptors of the central system, can relieve pain, with strong analgesic and sedative effects, commonly used drugs are dihydromorphone (5-10mg, intramuscular injection), pethidine (50-100mg intramuscular injection), prednisolone (50-100mg, intramuscular injection) and tramadol (100mg, intramuscular injection) and so on. Opioids should not be used alone in the treatment of renal colic, and generally need to be used together with atropine, 654-2 and other antispasmodic drugs.
3, antispasmodic drugs.
(1) M-type cholinergic receptor blockers, commonly used drugs include atropine sulfate and 654-2, which can relax ureteral smooth muscle and relieve spasm.
(2) Progesterone can inhibit the contraction of smooth muscle and relieve spasm, which is effective for pain relief and stone removal, usually at a dose of 20 mg, injected intramuscularly.
(3) Calcium blockers, nifedipine 10mg orally or sublingually, are useful in relieving renal colic.
(4), α-blockers have some effect in relieving ureteral smooth muscle spasm and treating renal colic. However, their exact efficacy remains to be observed in more clinical observations.
Treatment of the first episode of renal colic should be started with NSAIDs and switched to other drugs if the pain persists. Morphine and other opioids should be used in combination with antispasmodics such as atropine.
Diclofenac sodium tablets or suppositories of 50 mg twice/day for 3-10 days may be given when the ureteral stones are expected to have the potential to pass on their own.
In addition, acupuncture to stimulate Kidney Yu, Jingmen, Sanyinjiao or A-Yi points also has antispasmodic and pain-relieving effects.
Second, when the pain cannot be relieved by medication or the stone diameter is larger than 6mm, surgical treatment measures should be considered.
These include.
1.Extracorporeal shock wave lithotripsy (ESWL) The ESWL is used as an emergency management measure, through lithotripsy not only can control renal colic, but also can quickly release the obstruction.
2.Stent tube placed in the ureter can also be used with ESWL treatment.
3.Transureteral ureteroscopic lithotripsy for stone extraction.
4.percutaneous nephrostomy and drainage, especially for cases of renal colic with stone obstruction and severe infection.
During treatment, attention is paid to the presence of co-infection, the presence of bilateral obstruction can be isolated renal obstruction caused by oliguria, if these cases need active surgical treatment to release the obstruction as soon as possible.