Fluids and diuretics for acute ureteric colic.
BACKGROUND
Acute ureteric colic is a common cause of severe and debilitating pain. Theoretically, increasing fluid flow through the affected kidney might expedite stone passage, thereby improving symptoms more quickly. Unfortunately, for interventions such as high volume intravenous or oral fluids and diuretics that are aimed at doing this, the efficacy and safety is uncertain.


OBJECTIVE
To look at the benefits and harms of diuretics and high volume (above maintenance) intravenous or oral fluid therapy for treating adult patients presenting with uncomplicated acute ureteric colic.


METHODS
We searched the Cochrane Renal Group's specialised register (July 2004), the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library, issue 3, 2004), MEDLINE (1966 - July 2004), EMBASE (1980 - July 2004) and handsearched reference lists of nephrology and urology textbooks, review articles, relevant trials, and abstracts from nephrology scientific meetings. We sent letters seeking information about unpublished or incomplete trials to investigators known to be involved in previous trials.


METHODS
All randomised controlled trials (RCTs) and quasi-RCTS (including the first period of randomised cross-over studies) looking at diuretics or high volume intravenous or oral fluids for treating uncomplicated acute ureteric colic in adult patients presenting to the emergency department for the first time during that episode were to be included.


METHODS
Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI).


RESULTS
One trial (60 participants) was identified. This study compared no fluids for six hours versus three litres of IV fluids received over a six hour period. There was no significant difference in pain at six hours (RR 1.06, 95% CI 0.71 to 1.57), surgical stone removal (RR 1.20, 95% CI 0.41 to 3.51) or manipulation by cystoscopy (RR 0.67, 95% CI 0.21 to 2.13).


CONCLUSIONS
Unfortunately, we could find no credible evidence in the literature regarding either of these two treatment modalities. Given their potential positive impact, the role of diuretics and high volume fluid therapy in acute ureteric colic should be examined to determine their safety and efficacy in facilitating stone passage.
Worster
A
A
Emergency Medicine, McMaster University & Hamilton Health Sciences, Hamilton, ON, Canada. aworster@rogers.com
Richards
C
C
D000208:Acute Disease; D003085:Colic / Q000209:etiology / Q000628:therapy*; D004232:Diuretics / Q000627:therapeutic use*; D005440:Fluid Therapy / Q000379:methods*; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007552:Isotonic Solutions / Q000627:therapeutic use; D014514:Ureteral Calculi / Q000150:complications / Q000628:therapy*; D014515:Ureteral Diseases / Q000209:etiology / Q000628:therapy*
D004232:Diuretics; D007552:Isotonic Solutions; C028570:Ringer's acetate; D005947:Glucose