title: [Medical management of acute renal colic - there is more than hydration and Buscopan®...].
abstract: Renal colic is generated by hyperperistalsis of the obstructed ureter. Peristalsis is modulated by (among others) alpha-receptors (contraction), beta-receptors (relaxation) and prostaglandins (PG F2alpha: contraction, PG E1/E2: relaxation). Non-steroidal anti-inflammatory drugs (NSAID) are highly effective in pain relief and should always be given in the absence of contraindications. The same is true for metamizole, whereas Buscopan® is not superior to placebo. For most severe pain, opioids are indicated. alpha-blockers and calcium channel blockers dilate the distal ureter and increase the likelihood of spontaneous stone passage by up to 65%. Overhydration of patients has no advantage, but carries the risk of pelvic rupture with urine extravasation and infection. Stones of/above diameter 7 mm are unlikely to pass spontaneously and should be interventionally removed.
authors.affiliation: Innere Medizin und Nephrologie/Hypertonie, Klinik im Park, Zürich. bernhard.hess@hirslanden.ch
authors.forename: B
authors.initials: B
authors.lastname: Hess
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002086:Butylscopolammonium Bromide / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004177:Dipyrone / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006801:Humans; D009403:Nephrostomy, Percutaneous; D010276:Parasympatholytics / Q000627:therapeutic use*; D056844:Renal Colic / Q000188:drug therapy*; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D014517:Ureteral Obstruction / Q000188:drug therapy*
chemical_list: D000317:Adrenergic alpha-Antagonists; D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D010276:Parasympatholytics; D013449:Sulfonamides; D002086:Butylscopolammonium Bromide; D004177:Dipyrone; D000077409:Tamsulosin