Therapeutic target
Improvement of pain symptoms
Therapy recommendations
Note: According to the current S2k guideline, patients with newly diagnosed ureteral stone up to 7 mm in diameter can wait for spontaneous discharge with regular monitoring.
The most common treatment for acute renal colic is conservative therapy with the goal of spontaneous stone clearance (expulsion; medical expulsive therapy, MET):
- Fluid administration to increase urine output above 2 l/day.
- Analgesics (pain relievers): nonsteroidal anti-inflammatory drugs (e.g., indomethacin), metamizole, and opiod analgesic (tramadol).
- Spasmolytics (antispasmodic drugs).
- Alpha blockers* (tamsulosin)
- Indication for MET: calculi < 10 mm (DGU guideline: ≤ 5 mm), symptoms under control, renal function normal, and no urinary tract infection. Results:
- MET failed in 21%
- A study of 1,167 patients with symptomatic ureteral stone (≤ 10 mm) demonstrated that there was no statistically relevant difference for drug explusive therapy (MET): 400 µg tamsulosin or 30 mg nifedipine daily for 4 weeks) compared with placebo therapy.
- Concomitant therapy measures:
- Heat applications such as warm packs or warm full baths
- Bowel evacuation through an enema or laxatives
- Small urinary stones (< 5 mm) pass spontaneously in > 80% of cases! The time to spontaneous discharge is on average 30 to 40 days. This can be promoted by adequate hydration and exercise.
- To catch outgoing urinary stones, the patient should urinate over a sieve for this purpose. Subsequently, the stones should be analyzed to be able to initiate adequate metaphylaxis (protection against recurrence of the disease).
* Note: For one additional stone discharge, physicians must treat seven patients with alpha blockers.
Efficacy of analgesics in renal colic
- In a randomized-controlled trial, i.m. Application of an NSAID was more effective in relieving pain than an i.v. opioid. The study objective was at least 50% pain reduction after 30 minutes. The primary study objective, was achieved with diclofenac in 68%, with paracetamol in 66% and with morphine in 61% of patients. Furthermore, rescue analgesia (with the same agent) was required less frequently in the NSAID group (12% vs. 20% and 23%, respectively).
Other measures:
- Urinary diversion in cases of colic that cannot be controlled with medication, high-grade obstruction (occlusion) with consecutive urinary retention kidney and / or increasing retention values / accumulation of urinary substances (postrenal renal failure) – see below “Surgical therapy “If a ureteral splint is placed: Alpha blockers significantly reduce the discomfort caused by a ureteral splint.
- Chemolitholysis (stone-dissolving agents) – depending on the composition of the stone(s), see below Metaphylaxis (urinary stone prophylaxis) – and/or use of stone-dissolving drugs (diuretics/dewatering or diuretic drugs) if necessary.
- If the stone does not go spontaneously, then surgical therapy (see below “Surgical therapy; if necessary, also lithotrypsia) must be performed.
- See also under “Further therapy”
