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Ureteric colic has been an age-old problem encountered in medical practice. Ureteric stones are a known cause of this problem. Many conservative medical therapies have been researched and studied. Tamsulosin, an Alpha 1A specific inhibitor which was initially used in the treatment of benign prostatic hyperplasia has recently been shown to increase the rate of spontaneous passage of distal ureteral stones. Alpha adrenergic blocker Tamsulosin reduces muscles spasm in the ureteric wall, decreases peristalsis below and raises pressure above the stone thus facilitating stone passage. Use of Tamsulosin 0.4 mg daily in patients with distal ureteric stones is clinically safe and cost effective.

BACKGROUND Imaging plays a major role in the diagnosis and management of patients with urolithiasis. Non-Contrast Computed Tomography (NCCT) is generally accepted as the gold standard, but there are concerns over higher radiation exposure from NCCT to the patient population. Our prospective study compared the diagnostic accuracy of plain X-ray KUB (Kidney, Ureter, Bladder) and USG (Ultrasonography) with NCCT in the evaluation of patients with ureteric colic. METHODS This study conducted from December 2018 to January 2020 in the Department of Urology, Vijayanagar Institute of Medical Sciences, and attached Hospital. 230 patients with ureteric colic were evaluated for ureteric calculi with x-ray KUB, USG (Ultrasonography) abdomen and pelvis and NCCT (Non-Contrast Computed Tomography) KUB region. RESULTS Out of 230 patients, 168 (73 %) were males and 62 (26.9 %) were females. Ages of the study population ranged from 18 to 55 yrs. 198 of the 230 patients were confirmed to have ureteric calculus, with lower ureteric calculus 97 (48.9 %), upper ureteric 65 (32.8 %), middle ureteric 29 (14.6 %), and multiple 7 (3.5 %). X-ray and USG (Ultrasonography) group yielded a sensitivity of 86.3 %, a specificity of 87.5 %, positive predictive value 97 %, and negative predictive value 51 %. While On NCCT (Non-Contrast Computed Tomography), a total of 192 patients (96 %) demonstrated ureterolithiasis of the 198 patients confirmed to have ureteric calculi (Table 2). X-ray and USG group yielded a sensitivity of 96.9 %, specificity of 93.6 %, positive predictive value 98.9 %, and negative predictive value 83 %. CONCLUSIONS Combination of x-ray KUB and USG, and NCCT were found to be excellent imaging modalities for the detection of ureteric calculi. X-ray KUB and USG can be used as the first investigation of choice for patients with ureteric colic and for follow up of patients after treatment. KEYWORDS Ureteric Colic, Ureterolithiasis, Ultrasonography

OBJECTIVE To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). PATIENTS AND METHODS A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists. RESULTS Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of

Objective: To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi. Methods: A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus. Trans-abdominal ultrasound was initially done in all patients. In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dilation but no calculus was evident, trans-vaginal ultrasound was done. The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound. Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound. Results: As per the study protocol, 156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound. Trans-vaginal ultrasound was done in 149 patients, as seven patients did not give consent. Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gynecologic or other cause for their symptoms. Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography, among them only one patient had a lower ureteric calculus. Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound. Conclusion: Trans-vaginal ultrasound in addition to trans-abdominal ultrasound is a very useful tool in evaluation of sexually active females with suspected lower ureteric calculus. Keywords: Trans-abdominal ultrasound, Trans-vaginal ultrasound, Lower ureteric calculus, Ureteric colic, Ureter

BACKGROUND ESWL is suitable for stones smaller than 2 cm situated in upper and middle calyx. The routine insertion of DJ stents during ESWL of renal calculi is controversial. Some studies support the role of DJ stents in facilitating stone passage and preventing renal colic whereas other reports claim that stent causes significant lower urinary tract symptoms, hematuria, urinary tract infection and can even lower the stone-free rate. METHODS This is a prospective study conducted among 81 patients each in stented and non stented group who underwent ESWL for renal calculus. The primary outcome measured was stone fragmentation .The secondary outcomes measured were renal colic, urinary tract infection, steinstrasse and stent related LUTS. RESULTS Stone fragmentation rates in stented and non-stented groups were 91.4% and 86.4% respectively (p-value > 0.05). Ureteric colic in the stented group was only 14.8% but 45.7% in the non-stented group had ureteric colic (p-value

Patients with ureteric calculi usually present with ipsilateral “loin to groin” pain. Rarely ureteric colic may present with contralateral pain, which is referred to as “mirror pain”. We report the case notes of a rare presentation of contralateral ureteric colic or “mirror pain” secondary to a ureteric calculus. A comprehensive literature review was also conducted. “Mirror pain” or contralateral ureteric colic is rare. Urologists should be aware of this unusual clinical presentation and appreciate that upper urinary tract calculi can cause pain on the contralateral side.

INTRODUCTION AND OBJECTIVES:Ureteric colic is a common condition that causes severe pain and generates substantial health system utilization. Traditional management includes analgesia and a trial o...

Objectives: The objective was to determine accuracy of ultrasound in thediagnosis of ureteric calculi confirmed on non-contrast Computed Tomography amongpatients with acute ureteric colic. Study Design: Cross-sectional study. Setting: EmergencyDepartment of Nishtar Hospital, Multan. Period: 11-07-2012 to 10-01-2013. Materials andMethods: 100 consecutive patients presenting with acute severe ureteric colic and fulfillingthe inclusion and exclusion criteria were enrolled for the study from the emergency departmentof Nishtar Hospital Multan. Ultrasonography was done in all patients and USG findings wererecorded for the presence or absence of hyperechoic shadows in the ureteric. All the patientsunderwent CT scan to confirm or refute the findings of Ultrasonography. Result: Mean age ofthe patients was 37.85 + 12.60 years. Males were 53 (53%) while females were 47 (47%). Meanduration of pain before presentation was 14.81 + 6.20 hours. Mean severity of pain on visualanalogue scale was 9.40 + 0.8. Overall 79 patients were diagnosed as having ureteric calculi.Ultrasonography detected the ureteric stone in 75 patients and was all found to have stoneon CT scan and represented true positives. Among 25 patients in whom ultrasound did notdemonstrate any stone, 4 were found to have ureteric stone on CT scan thus representing falsenegative whereas 21 (84%) were confirmed on CT scan not to have any stone, thus representingTrue negatives. The sensitivity of USG for detection of ureteric stone was found to be 94.9%,the specificity was 100%, and positive predictive value was 100% while negative predictivevalue was 84% .There was no significant effect of age or gender on the accuracy of ultrasound.Conclusion: Ultrasonography is a readily available, non-invasive and reliable investigation inpatients presenting with acute flank pain to diagnose ureteric stones with a specificity of 100%and a sensitivity approaching 95%. Thus it is recommended that it should be used routinely forthe evaluation of patients presenting with acute flank pain.

Acute flank pain is a common presentation to the emergency department (ED), and imaging studies play an important role in establishing an accurate diagnosis. Computed Tomography of Kidneys, Ureters, Bladder (CT KUB) has surpassed all other imaging modalities to become the gold standard in detection of ureteric calculi. The purpose of this study is to identify the range and management of alternative diagnoses established by CT KUB in patients with suspected ureteric colic. Two hundred and fifteen consecutive CT KUB examinations ordered in the ED of a tertiary-care centre for suspected ureteric colic were retrospectively reviewed. This comprised of 134 male (62.3%) and 81 female (37.7%) patients with a mean age of 53 years old. The positive detection rate for ureteric calculi in males was 43.3% compared to a lower rate for females of 29.6% (p < 0.05). Almost two-thirds of patients were discharged following CT KUB imaging, and admission rates were significantly higher in those with alternative radiological findings (p < 0.04) Alternative radiological findings occurred in 72 patients (33.5%), including 15 patients (7.0%) who had clinically important alternative pathology. The rate of clinically important alternative findings was significantly higher in males than females, 9.7% versus 2.5% respectively (p = 0.04). Surgical intervention was more common in patients with alternative radiological findings classified as gastrointestinal (18.2%) compared to non-gastrointestinal (3.6%), however this did not reach statistical significance (p = 0.07). In conclusion, significant alternative pathology was identified using CT KUB in 7% of patients with suspected ureteric colic. The low rates of detection of ureteric calculi and significant alternative pathology in female patients suggests a more thorough clinical assessment is warranted to improve their management, prior to ordering investigations with exposure to radiation.

Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC. We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016. Patients who had both CT KUB and CTU were then compared to determine if CT KUB had missed a UTUC and if the diagnoses were concordant by the two tests. A radiologist independent from the reporting radiologists reviewed images as well as their reports. According to the Health Research Authority, England regulations, we did not obtain an ethical review on a voluntary basis for this retrospective study. Four hundred eighty-five patients [228 (47.01%) male and 257 (52.99%) female] had a CT KUB scan over the 34-month period. Their mean age was 74 (SD 6.97) [males 73 (SD 6.42), females 75 (SD 7.42)] years. One hundred eighty-seven scans were normal. Ureteric calculi (167), renal calculi (58) and renal cysts (28) were most frequent diagnoses. The diagnosis was uncertain in 33 patients (6.8%) [16 (48.49%) males and 17 (51.51%) females]. The mean age of this group of patients was 74 (SD 6.64) [males 73 (SD4.43), females 74 (SD7.64)] years. These patients had a CTU for clarity. CTU identified one UTUC not identified by CT KUB (0.2%), corroborated the diagnosis of a ureteric tumour in one patient and excluded UTUC in two others. CTU diagnosed two new bladder tumours and an endometrial tumour. Diagnoses were concordant between CT KUB and CTU in 17 of 33 patients (51.5%). CT KUB scans for patients 65 years and over presenting with ureteric colic is justified. Only a small proportion of patients will subsequently require the higher radiation dose CTU as the probability of missing UTUC is low.

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone; 2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.

Medical expulsive therapy (MET) is one of the most common conservative modality of treatment offered by general practitioners for ureteric colic and calculi. In many occasions, such treatment may have beneficial effect, but might be counter-productive, if offered inappropriately. We report a case of unilateral pelvi-ureteric junction obstruction with a large, redundant, extra renal pelvis that was misinterpreted in ultrasonography as hydroureteronephrosis. The dilatation was assumed to be due to ureteric calculus and hence treated with MET, that resulted in forniceal rupture and urinoma. The aim of this article is to highlight the possible catastrophe that can result as a result of inappropriate administration of MET, especially in those patients treated based on empirical diagnosis of ureteric colic.

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.

A 58-year-old gentleman presented with right side ureteric colic for six months duration. He had undergone an extended pyelolithotomy for a pelviureteric junction calculus 10 years back and he had defaulted follow up. His X-ray KUB revealed a large renal calculus with a calcified feeding tube, along with a large bladder calculus with encrustation of the tube in the bladder. Cystolitholapaxy was performed for the bladder calculus, and percutaneous nephrolithotomy was performed and the renal calculus along with the calcified feeding tube was removed. At the end of the procedure, the patient was left with only a single incision of 2cm length.

A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature.

Renal (ureteric) colic is a common surgical emergency. It is usually caused by calculi obstructing the ureter, but about 15% of patients have other causes, e.g. extrinsic compression, intramural neoplasia or an anatomical abnormality. This review will focus on calculus-related renal or ureteric colic, its assessment and subsequent management.

Aortic aneurysms are very rare in Middle East unlike Europe and America. Therefore, this pathology is very likely to be missed in acute presentation to the Emergency Medicine Department. We present a case of leaking abdominal aortic aneurysm mimicking right ureteric colic, which was missed in the initial assessment.

Objective: To assess the accuracy and benefit of urgent bedside ultrasound scanning in urological emergencies by urology trainees. Methods: In this prospective study, 111 patients (86 acute flank pain, 15 renal failure, 10 haematuria) referred as urological emergencies, were scanned for urinary tract abnormalities at the bedside, by a trainee urologist, over 18 months. The ultrasound findings were compared with the results of imaging performed by a consultant radiologist and its influence on clinical management analysed. Results: Bedside ultrasound proved life saving in 5 patients (2 pyonephrosis, 2 leaking aneurysms, one bilateral ureteric injury). It significantly influenced management in 11 patients, excluded obstruction in the presence of infection in 13 patients, helped in early diagnosis in 32 patients and ruled out gross urological pathology in 28 patients. It was misleading in 22 patients, mainly with ureteric colic (where the timing of the test can affect the findings), though the outcome was not adversely affected in any. Bedside ultrasound was reasonably accurate (sensitivity 81% and specificity 92%). Conclusions: Bedside ultrasound is a useful tool to help the decision-making in urological emergencies and reasonably accurate in hands of a trainee urologist. It is especially helpful for excluding obstruction in presence of infection or renal failure. However it has inherent limitations in assessing acute ureteric colic.

Objectives: 1. To investigate the diagnostic accuracy of urinalysis and the plain abdominal radiograph in predicting positive intravenous pyelography for patients with a history and examination suggestive of ureteric colic. 2. To examine the disposition of patients presenting to the emergency department with ureteric colic. Methods: A retrospective cohort study set in a tertiary referral hospital emergency department over a 12-month period was conducted. Three hundred and eighteen patients who presented with a provisional diagnosis of ureteric colic and had intravenous pyelography were identified from radiology department logs and emergency department discharge International Classification of Disease-9 codes.Results: Three hundred and eighteen patients were identified. Sixty-nine per cent had positive intravenous pyelography. Sensitivity and specificity of: urinalysis were 93% and 41%; abdominal X-ray, 57% and 83%; and urinalysis plus abdominal X-ray, 99% and 36%, respectively. Seventy-seven per cent were admitted to the emergency department observation ward. Twenty-seven per cent were subsequently admitted under the hospital's urology service. Conclusions:Sex, haematuria and the presence of a calculus on abdominal X-ray were all significant predictors of positive intravenous pyelography. Haematuria was sensitive but not specific for positive intravenous pyelography. The addition of the abdominal X-ray marginally improves the diagnostic accuracy.

Non contrast helical computed tomography (CT) study of the abdomen is frequently performed in evaluation of suspected ureteric colic. We present CT images of a young adult male patient who had torsion of an undescended, non-neoplastic testis and describe the “Inguinoscrotal whirlpool sign on CT”.

A significant proportion of emergency urological admissions are comprised of ureteric colic presenting as loin pain. A variety of alternative pathologies present in this manner and should be considered during systematic assessment. We report the case of a patient admitted with severe unilateral back and flank pain after strenuous deadlift exercise. Clinical examination and subsequent investigation following a significant delay demonstrated acute paraspinal compartment syndrome (PCS) after an initial misdiagnosis of ureteric colic. The patient was managed conservatively. We review the current literature surrounding the rare diagnosis of PCS and discuss the management options.

Objective : Sonography is unfrequently used for direct visualisation of ureteric calculi. In a sonography prospective study with 3 experienced examinators, sonographical results in primary detection of ureteric calculi were compared to plain renal radiography and intravenous urography. Methods : In a prospective study, patients with suspected renal or ureteric colic were examined using both sonography and excretory urography. The only diagnostic criterion for sonography was the evidence of a calculus, while for excretory urography direct and indirect indications of a calculus were permitted. Results: Sixty two patients were examined using ultrasound and excretory urography. In detecting ureteric calculi, sensitivity of sonography and excretory urography was 93% and 76%, and specificity was 93% and 100%, respectively. In the present study, plain renal radiography was relatively less conclusive as a diagnostic tool for the detection of ureteric calculi and does not seem to be necessary as an additional procedure to sonography. In the case of renal calculi, sonography and excretory urography achieved a sensitivity of 94% and 77%, respectively, and a specificity of 100% each. Conclusions: Ultrasonographic examination carried out by a well-experienced investigator, using the graded compression technique, should be used as the primary examination method. Additional excretory urography remains open if there is a discrepancy between clinical symptoms or findings and sonographical diagnosis.

The incidence of ureteric colic is probably unchanged by pregnancy, ranging from 1 in 1,500 to 1 in 2,500 – the same as in nonpregnant women (Coe et al. 1978). Some authors have suggested the incidence increases significantly up to 1 in 200 (Cormier et al. 2006), although evidence to support this is limited. Ureteric colic in pregnant women tends to occur during the second or third trimester (Stothers and Lee 1992). Both urinary calcium and uric acid excretion increase in pregnancy (predisposing to stone formation), so too do urinary citrate and magnesium levels (protecting against stone formation). The development of a ureteric stone during pregnancy is a significant event for four important reasons

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators' experience, patients' preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Background: Ureteric colic is a common presentation in the emergency department and accounts for approximately 1% of all hospital admissions. Diagnosis depends on a typical history, clinical examination and the presence of haematuria. Intravenous urography has traditionally been used as the means of investigation, but over recent years this has been superseded by CT urography. This latter investigation gives potentially more information and may detect alternative or additional pathology which would otherwise be missed on intravenous urography. Methods: 100 consecutive patients attending the emergency department with a provisional diagnosis of ureteric colic undergoing CT urography were studied to detect the incidence of alternative or incidental pathology. Results: Stone disease was found in 58% of patients, with obstruction present in 43%. The most common site of obstruction was the vesicoureteric junction. Significant incidental or alternative pathology was found in 16% of patients. It was estimated that, in 12%, these findings would not have been detected by intravenous urography. Conclusion: The use of non-contrast CT urography is recommended in the initial investigation of patients with ureteric colic.

The diagnostic approach to ureteric colic has changed due to the introduction of new radiological imaging such as non-contrast CT. The role of intravenous urography, which is regarded as the gold standard for the diagnosis of ureteric colic, is being challenged by CT, which has become the first-line investigation in a number of centres. The management of ureteric colic has also changed. The role of medical treatment has expanded beyond symptomatic control to attempt to target some of the factors in stone retention and thereby improve the likelihood of spontaneous stone expulsion.

While hypercalciuria and uric acid excretion increase in pregnancy (predisposing to stone formation), so too do urinary citrate and magnesium levels (protecting against stone formation). The net effect is that the incidence of ureteric colic is the same as in nonpregnant women (Coe et al. 1978). Depending on what series you read, somewhere between 1 in 1500 to 1 in 2500 pregnancies are complicated by ureteric stones. The great majority of ureteric stones in pregnant women occur during the second and third trimesters (Stothers and Lee 1992). The development of a ureteric stone during pregnancy is an important event, not only because it results in pain, the cause of which can be difficult to establish and to distinguish from other causes, but also because it can be difficult to treat and because it is associated with a significant risk of preterm labour (Hendricks et al. 1991).

Background: Electrohydraulic lithotripsy (EHL) has been available for endoscopic treatment of urinary calculi since 1960, but the large probe size and concerns regarding safety had previously restricted its use to the treatment of bladder calculi. However, recent refinements have made it particularly suitable for the treatment of ureteric calculi. Methods: The authors report their initial experience using EHL in conjunction with mini-ureteroscopy in the treatment of 94 ureteric calculi in 89 patients. The size of the calculi ranged from 3 to 19 mm in diameter, with a mean of 8.2 mm. The mean operating time was 29 min, ranging from 10 to 120 min. Results: A complete fragmentation rate of 91.5% of the calculi was achieved. There were no major complications and a low incidence of minor complications: haematuria (2.2%), urinary tract infection (3.4%) and postoperative ureteric colic (2.2%). There were four cases of minor ureteric perforations (4.5%); all were successfully treated using conservative measures. Conclusions: It is concluded that EHL is a safe and effective method of treating ureteric calculi.

Background Patients presenting in the emergency room with flank pain suggestive of acute ureteric colic may have alternative underlying conditions mimicking ureteric stones. An early diagnosis and appropriate treatment for other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT (UHCT) for evaluation of ureteric colic. This study was conducted to determine the incidence and spectrum of significant incidental diagnoses established or suggested on UHCT performed for suspected renal/ureteric colic. Methods Urologist and radiologist reviewed 233 consecutive UHCT, performed for suspected renal/ureteral colic along with assessment of the medical records. Radiological diagnoses of clinical entities not suspected otherwise were analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Results Ureteral calculi were identified in 148 examinations (64%), findings of recent passage of calculi in 10 (4%) and no calculus in 75 examinations (32%). Overall the incidental findings (additional or alternative diagnosis) were found in 28 (12%) CT scans. Twenty (71%) of these diagnoses were confirmed by per-operative findings, biopsy, and other radiological and biochemical investigations or on clinical follow up. Conclusion A wide spectrum of significant incidental diagnoses can be identified on UHCT performed for suspected renal/ureteral colic. In the present series of 233 consecutive CT examinations, the incidence of incidental diagnosis was 12%.

Objective: To determine whether patients with proven ureteric calculi on IVU require repeat IVU after resolution of symptoms and passage of calculus on plain X–ray. Methodology: IVU reports for a 12–month period were obtained and notes and X–rays of those patients with ureteric calculi were reviewed. Presentation, management and subsequent imaging after resolution of symptoms were determined for each patient. All X–rays were reviewed by a uroradiologist. Results: Fifty–eight patients were investigated for the study. All initial IVUs showed upper tract dilation or obstruction. Forty–three eventually passed their calculi spontaneously and of these, 18 had KUB, all of which showed passage of the calculus and 25 had repeat IVU, 22 of which were normal. The 3 abnormal IVUs showed persisting calculi which were visible on the plain film. Fifteen patients required surgical intervention and all had repeat IVU, of which 5 were abnormal. Conclusion: This study suggests that following resolution of symptoms due to ureteric colic, patients who pass their calculi spontaneously can be followed up by KUB. Only those with persistent calculi on KUB or those who have had surgical intervention require repeat IVU.

Patients with ureteric stones present in many ways. Ureteric colic is dramatic, painful and distressing to even the observing relative. Anuria is disastrous. Many physicians in the third world do not realize the significance of obstructive anuria and treat it by forcing fluid or furosemide. Both colic and anuria are emergencies that require attention. Ureteric stones can also lie undiscovered, whilst insidiously destroying the kidney, a not too uncommon event.

A 34 year old man visits his general practitioner with a short history of intermittent severe pain radiating from his right loin to right groin. He is unable to get comfortable and is also complaining of urinary frequency and occasional urgency. His temperature is normal. A urine dipstick test shows only non-visible haematuria. The initial diagnosis is suspected renal/ureteric colic secondary to a stone. Important features to explore in the history include

Purpose: Now a day's Renal & Ureteric calculi is very common problem in our society. In this patient experiences so much Renal pain, Ureteric colic, Haematuria, Recurrent UTI & they disturbed his daily routine work. Modern Medicines have limitations to treat it & advised Surgery to many patients. A poor & middle class patient was not tolerating surgical expenses. And there were chances of recurrences also. So I thought to use combinations to dissolve renal & Ureteric calculi and cure patients. Method: I had chosen Stonvil Capsule (Phyto Pharma) & Varunadi Kwath. Stonvil Capsule contains multiple ayurvedic drugs. I gave one Stonvil capsule with 10ml Varunadi Kwath three times a day. Before & after treatment I advised USG, Xray. Result: This Clinical study is done on 20 patients in K.G.Mittal Hospital. After starting treatment patient had relieves renal pain, Ureteric colic, Haematuria, Recurrent UTI within 1 to 4 days. Also relieves Burning Micturation & them able to do their daily routine work. This treatment was also effective in gall bladder calculi. After every 3 months advised to do USG. In some patients calculi disappeared (dissolved) after 3 months. But In some patients calculi took 6 months or more periods to dissolve. After dissolved the calculi, 1 month treatment also given for the nonrecurrence. Calculi didn't recur after treatment. Multiple calculi in two patients also dissolved by this treatment. Conclusion: Over all study the patients cured from renal & Ureteric calculi. Patient had relieved Renal pain, Ureteric colic, Haematuria, Recurrent UTI within 1 to 4 days. Also relieved Burning Micturation. Calculi dissolved & flushed out through urethra & didn't recur. Calculi disappeared in after treatment USG. Patients having multiple calculi didn't need surgery.

Although I agree with Rogawski and Khafagy that all patients with type 2 diabetes and renal colic need acute hospital admission and that ureteric colic should be diagnosed radiographically, I question the …

Acute ureteric colic is thought to be produced by a calculus producing back pressure in kidneys and by increased production of prostaglandins. There is no ideal drug for acute ureteric colic as responses to various analgesic/ antispasmodic drugs vary between patients. This study was designed to assess the role of parenteral diclofenac sodium in the treatment of this painful condition.

Several unwarranted investigations are usually performed in patients with acute ureteric colic owing to suspected stones in the urinary tract. The present study was undertaken to identify the efficacy of ultrasonographic scanning (USS) as an alternative to emergency intravenous urogram (IVU) in such patients. 150 patients attending the stone clinic with acute ureteric colic formed the test group, while 50 other patients with acute ureteric colic formed the control group. In the test group, all patients had a plain X-ray of the kidney, ureters and bladder (KUB) and USS done. In the control group, an IVU was performed. The advantages of using two approaches in deciding treatment were evaluated.

We report our experience with pulsed dye laser lithotripsy in the treatment of 100 ureteric stones in 95 patients over a 14-month period from July 1989 to September 1990. The overall rate of successful stone fragmentation was 97%. There was a low incidence of minor complications--mild haematuria, ureteric colic and urinary tract infection; ureteric perforation occurred in only 3 patients, all of whom were successfully treated conservatively. Pulsed dye laser lithotripsy is a safe and effective mode of treatment for ureteric stones. Current indications for laser fragmentation of stones are ureteric stones, impacted pelviureteric junction stones and Steinstrasse.

The pain experienced as a calculus passes from the renal pelvis to the bladder may be extremely severe or it may be a mere discomfort. The degree of pain is unrelated to the size of the stone but is due mainly to ureteric spasm and, to a lesser extent, to the ureteric and calyceal distension secondary to the obstruction.

Summary— A randomised multicentre clinical trial was undertaken to compare the effect on pain of indomethacin administered either intravenously or rectally to 116 patients with ureteric colic. Adverse reactions were also assessed. Of the patients receiving the intravenous injection, 48/53 (91%) achieved good pain relief (i.e. no supplementary analgesia was required) 30 min after administration, compared with 46/63 (73%) receiving the enema. Significantly more side effects occurred in the group treated intravenously. It was concluded that indomethacin administered as an enema was less effective than the intravenous form, but it should be regarded as a good alternative in the treatment of ureteric colic.

Flexible retrograde ureteroscope is now being widely used in endoscopic management of the urinary calculi. We report technique of supine ante grade flexible ureteroscopy in treating impacted upper and mid ureteric calculi in a pediatric patient. A six year-old boy with a history of acute right ureteric colic was investigated and found to have right upper and middle impacted ureteric calculi. He was planned for ureteroscopy, but the intramural part of the ureter could not be dilated. Hence, a decision was taken to do an antegrade flexible ureteroscopy in the supine position. An antegrade renal access was established in the supine position using ultrasound- guided puncture, a 22 Fr Amplatz was placed after serial dilatation of the tract and the stones were accessed using a flexible ureteroscope. The stones were then disintegrated using holmium laser. The ureter was stented at the end of the procedure. IVU done after six months revealed normal right kidney.

OBJECTIVE: (1) To determine the accuracy of accident and emergency (A&E) doctors' diagnosis of radio-opaque ureteric calculi on plain abdominal radiographs; (2) to study the predictive value of haematuria with a history suggestive of ureteric colic. DESIGN: A prospective study of all patients seen in a three month period with a provisional diagnosis of ureteric colic. Intravenous urography (IVU) was used as the gold standard for diagnosis of ureteric calculi. SETTING: The accident and emergency department and medical unit of a large teaching hospital. SUBJECTS: 60 patients who were admitted with an initial diagnosis of ureteric colic, 51 subsequently undergoing intravenous urography. RESULTS: A&E doctors achieved a calculated sensitivity of 29% (95% confidence intervals 13% to 49%) and a specificity of 73% (52% to 90%) for identification of renal calculi on plain abdominal radiograph, compared with figures of 68% (48% to 84%) and 96% (78% to 100%) respectively for consultant radiologists. The difference between these results was highly significant (P = 0.0011). No patient with a definitive diagnosis of ureteric colic had a negative result for haematuria on urinary dipstick analysis. CONCLUSIONS: A&E doctors are poor at identifying radio-opaque ureteric calculi on plain abdominal radiographs. If haematuria is absent on urinalysis then ureteric colic is an unlikely diagnosis.

Summary A clinicopathologic correlation of 2 patients with crossed renal ectopia presenting with ureteric colic and 4 cases collected from the literature is presented. The correlation serves to reaffirm the theory of ureteral and not renal, migration as the primary aberration resulting in this defect.

The effectiveness of parasympathicolytic drugs in the treatment of ureteric colics is doubtful. Bencyclane is a new myotropic substance. Its spasmolytic effect on smooth muscle is five times stronger than that of papaverine. The results of the clinical use of Bencyclane in cases of ureteric colic are described and discussed.

Two cases of cystic dilatation of the intrahepatic biliary tree are described. Both patients succumbed to recurrent bile stasis, cholangitis and septicaemia. The pre-operative diagnosis is not easy but should be considered in patients who have symptoms of biliary tract disease and recurrent urinary tract infections, ureteric colic or haematuria; particularly if urography demonstrates renal cysts or medullary sponge kidney.

Summary— In this study the analgesic effect of indomethacin in ureteric colic was demonstrated in 15 patients. Of the 15 patients, 12 had prompt and effective pain relief. It is concluded that indomethacin suppositories offer a safe and effective alternative to pethidine in the treatment of ureteric colic.

Ureteric colic is a painful emergency. This paper examines the relative benefits of plain x-rays of the kidney/ureter/bladder (KUB) region and pyelograms in an emergency setting.

A randomised prospective double-blind study of the effect of 1 mg glucagon intravenously was done on 51 consecutive patients with acute uretic colic. No significant difference between glucagon and placebo could be demonstrated as to pain relief or passage of calculi.

Ureteric obstruction causes increased synthesis and release of prostaglandins. As a result renal pelvic pressure rises, causing renal colic. This double-blind study in 66 patients with acute renal colic shows that intramuscular injection of a potent prostaglandin-synthetase inhibitor (diclofenac sodium) is more effective and has fewer side-effects than a narcotic drug commonly used to treat ureteric colic.

Diagnostic accuracy in identifying calculi in patients with ureteric colic is poor. Lower ureteric calculi may be confused with other pelvic calcific opacities. A characteristic appearance of some larger lower ureteric calculi is described and likened to the root of a tooth. It is hoped that the tooth-root sign will be of assistance in the diagnosis of distal ureteric stones.

The management of pain from ureteric colic (UC) has depended until now upon antispasmodic agents (AA) and, if ineffective, opiates. However, the high failure rate with AA and the risk attached to opiates makes this approach inadvisable. It has recently been proposed that UC be treated with indomethacin1, a nonsteroidal anti-inflammatory drug (NSAID), which inhibits PG biosynthesis thereby counteracting the effects of PGE2 on ureteric wall tone and glomerular filtration rate, both of which increase the pressure above the stone and evoke pain2,3.