The ideal analgesic treatment for acute renal colic--theory and practice.
OBJECTIVE
With an annual incidence of 0.1-0.4%, renal colic is certainly a frequent disorder. Thanks to recent findings, the approach to treatment is changing. This prompted us to conduct a survey amongst all urologists in Switzerland regarding the analgesic measures they use in patients suffering from acute renal colic.


METHODS
In March 2005, we sent a total of 170 questionnaires to all practising urologists who are also members of the Swiss Urology Society. The questions covered the types of drugs used for first- and second-line analgesic therapy in acute renal colic and the approach to acute and follow-up analgesic therapy. Dosage adjustments in patients with renal failure were also included. The responses were compared with recent literature findings and international guidelines.


RESULTS
The response rate was 58%. Non-opioid analgesics are used for first-line therapy by 81% of respondents, with metamizol being used in 64% of cases. First-line therapy is given intravenously in 65% of cases. An opioid (pethidine) is used most frequently as acute second-line therapy (74% of cases). In the presence of renal failure, half of the respondents make a dose adjustment to the analgesic. Follow-up therapy consists mainly of non-steroidal anti-inflammatory drugs (75%). This complies with the literature and with the recommendations of the European Association of Urology.


CONCLUSIONS
First-line therapy for acute renal colic should consist of a non-opioid analgesic, and only if the response to this is inadequate should opioids then be used.
Engeler
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DS
Klinik für Urologie, Kantonsspital St. Gallen, St. Gallen, Switzerland. daniel.engeler@kssg.ch
Schmid
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Schmid
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D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D003085:Colic / Q000188:drug therapy*; D005060:Europe; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D008962:Models, Theoretical; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics