[Efficient, immediate or emergency ESWL: an attractive strategic alternative to be considered in the treatment of renal colic!].
BACKGROUND
Renal colic due to acute ureteral obstruction caused by lithiasic impact results in severe rise of intracavitary pressure. Traditional drug therapy (painkillers, anti-inflammatories, spasmolytics) is symptomatic and provisional, and pain can reappear when obstruction is maintained. A pathoetiological approach would be the ultimate therapy vs the symptomatic one.


METHODS
From the beginning, the approach used at the Lithiasis-Lithotrity Unit at the FJD, once the ureteral stone is accurately identified during a renal colic, is that of immediate or emergency "in situ" SWEL together with the usual drug therapy. 15% of 2100 cases of ureteral lithiasis treated (1991-1999) were renal colic.


RESULTS
Renal colic can be resolved in all cases (100%) even when fragmentation may be partial and/or require a second deferred SWEL on remnants of the first lithiasis. When obstruction has been resolved, pain does not reappear as it happens with the effects of analgesics.


CONCLUSIONS
Placement of a ureteral catheter or nephrostomy for analgesia in order to perform deferred SWEL of the ureteral stone origin of the acute ureteral obstruction and the renal colic, do not improve SWEL results. There are physical reasons to support the practice of immediate or emergency "in situ" SWEL during a renal colic. Fragmentation of the obstructive stone together with the resulting ureteral oedema allow urine passage. Intracavitary pressure and pain disappear when the obstruction is withdrawn.


CONCLUSIONS
Immediate, "in situ" or emergency SWEL in cases of obstructive ureteral stones during a renal colic, is an attractive strategic alternative for drug therapy that should be considered mainly in institutions with means to perform the procedure.
González Enguita
C
C
Cátedra y Servicio de Urología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid.
Cabrera Pérez
J
J
Calahorra Fernández
F J
FJ
García Cardoso
J
J
Vela Navarrete
R
R
D003085:Colic / Q000209:etiology / Q000628:therapy*; D004630:Emergencies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D014514:Ureteral Calculi / Q000150:complications / Q000628:therapy*; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy