Acute Renoureteric Pain

Sudden & severe (colic or continuous)

Loin to groin
Unpleasant sensory & emotional experience

Radiation of Pain
Kidney UQ & gonads Upper third ureter UQ Mid third ureter LQ Lower third ureter - LQ & groin Intravesical ureter - LQ & frequency & urgency

Cause
Renal/ureteric stone (85%) Extrinsic obstruction (10%) Intrinsic obstruction (5%)

Cause of Pain
1. Increased pressure - mechanoceptors 2. Mucosal inflammation - chemoceptors & PGE 2 3. PGE 2 - vasodilation - sensitize nociceptors

Symptoms
1. 2. 3. 4. Pain Nausea & vomiting Tachycardia Decreased intestinal peristalsis

Signs
1. Restlessness 2. Renal angle deep tenderness 3. Lateral abdominal guarding

Investigations
1. Urine - red cells - cystine crystals (hexagonal) 2. NCCT 3. US & X-ray KUB

Cyclo-oxygenase (COX) Inhibitors

Decrease PGE 2 production Nonselective (NSAID) - Acetylsalicylic acid - Indomethacin - Diclofenac Selective 1 (Ketoprofen) Selective 2 (Rofecoxib)

Pain Management
1. NSAID - Diclofenac (Tab 50mg, IM inj 75 mg) 2. Mild Opioid - Tramadol (50 100mg IM) 3. Strong Opioid - Pethidine (25mg IV)

Pain Management
1. Admission - fever - vomiting 2. Surgery - anuria - infection - intractable pain

Conservative Management (Spontaneous Passage)

1. 2. 3. 4. Less than 5 mm Observation for 4 weeks US & X-ray KUB Stone expulsive drugs - tamsulosin - nifedipine

Renal & Ureteric Calculus: Symptoms

1. 2. 3. 4. 5. Pain (fixed renal/colic) Hematuria Acute pyelonephritis/Pyonephrosis Anuria/Renal failure Asymptomatic

Renal & Ureteric Calculus:Signs

1. Tenderness & guarding (Acute stage) 2. Mass (hydronephrosis)

Renal & Ureteric Calculus:Investigations

1. 2. 3. 4. 5. NCCT US & X-ray KUB IVU Urine microscopy Urine culture

Ureteric Calculus: Surgical Management

Bladder Calculus: Evaluation

Voiding symptoms, hematuria, asymptomatic Rectal exam US or X-Ray KUB Cystoscopy

Bladder Calculus: Management

Endoscopic Lithotripsy Percutaneous Lithotripsy Cystolithotomy Causal (migrant or native)

Urethral Calculus: Evaluation