title: Evolving Guidance on Ureteric Calculi Management in the Acute Setting.
abstract: Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.
authors.affiliation: The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. jonathan.makanjuola@nhs.net.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Makanjuola
authors.affiliation: The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. s.rintoul-hoad@doctors.org.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rintoul-Hoad
authors.affiliation: The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. matthew.bultitude@gstt.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bultitude
mesh_terms: D000208:Acute Disease; D004032:Diet; D006801:Humans; D008019:Life Style; D009403:Nephrostomy, Percutaneous; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy
keywords: Computer tomography; Medical expulsive therapy; Nephrostomy; Tamsulosin; Ureteric colic; Ureteroscopy