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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.

Introduction: This retrospective study investigates the role of the emergency ureteroscopic (URS) approach in the definitive treatment of ureteric stones.Methods: We reviewed all patients admitted for ureteric stones from May 2003 to December 2010. Those who underwent URS stone treatment were selected and stratified into emergency (EMG) and elective groups (ELG). Emergency URS is defined as URS being performed within 24 hours of admission to the emergency room. The main indication for emergency treatment was refractory ureteric colic in spite of narcotic analgesia. Both groups were statistically compared in terms of their patient-, stone- and outcome-related variables. The overall success rate was defined by the clearance of the stone and/or presence of residual fragments (

Aim: To evaluate the sensitivity and specificity of noncontrast helical computerized tomography (CT) in ureteric colic with comparative evaluation of KUB and ultrasonography (USG). Setting: Tertiary care university hospital. Materials and Methods: One hundred patients aged between 20 and 75 years referred from the emergency department as acute ureteric colic were evaluated with KUB and USG followed by noncontrast helical CT. Results: Noncontrast helical CT was 91% sensitive and 98% specific in detecting urolithiasis compared to a sensitivity of 20% and 30% for KUB and USG and specificity of 94% and 98% respectively. Conclusion: Noncontrast helical CT is a very sensitive and specific investigation for evaluation of acute flank pain due to urolithiasis, besides helping in the detection of nonrenal causes of pain.

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.

Aim To establish whether non-contrast enhanced computed tomography (NCCT) renders the kidneys–ureters–bladder (KUB) radiograph redundant as the initial imaging investigation for suspected acute ureteric colic. Materials and methods The imaging investigations for 120 patients consecutively admitted to an emergency department-led clinical decisions unit (CDU) with suspected acute ureteric colic were retrospectively reviewed. A multidisciplinary meeting reviewed the findings and recommended that KUB radiographs should not be routinely performed prior to NCCT. Prospective assessment of 116 consecutive patients admitted over a comparable period was then undertaken. Results In the retrospective group, 61 (50.8%) patients had calculi to account for symptoms (positive NCCT) and 59 (49.2%) patients did not have stone disease (negative NCCT). Ninety (75%) patients had a KUB radiograph prior to NCCT. However, in 46 (38% of total) of these patients the NCCT was negative for stones, and therefore, they had been subjected to an unnecessary radiographic examination. These results prompted a change in practice. In the subsequent and prospectively studied group, preliminary KUB radiographs were performed in only 6% of the patients, with no significant change in the positive NCCT rate (50.8 versus 51.7%) or the total number of examinations performed (120 versus 116). Conclusion NCCT should be the initial imaging examination for acute ureteric colic. Up to 50% of patients with clinical suspicion do not have stone disease, and therefore, preliminary KUB radiographs with attendant radiation and cost implications are unjustified. Preliminary KUB radiographs can be omitted from the imaging pathway with no resultant indication creep or increase in demand for NCCT examinations.

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.

Objective: Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. Methods: This was a prospective study of a convenience sample of all adult non-pregnant patients with presumed ureteric colic attending the ED with prior ethics committee approval. An emergency physician or registrar performed a focused ultrasound scan and were blinded to the patient’s other management. A computerized tomography scan was also performed for all patients while in the ED or within 24 h of the EPU. The accuracy of EPU detection of hydronephrosis was determined; using computerized tomography scans reported by a senior radiologist as the ‘gold-standard’. Results: Sixty-three patients with suspected ureteric colic were enrolled of whom 57 completed both EPU and computerized tomography imaging. Forty-nine had confirmed nephrolithiasis by computerized tomography with 39 having evidence of hydronephrosis. Overall prevalence of hydronephrosis was 68% (95% confidence interval [CI] 56–79%); compared with computerized tomography, EPU had a sensitivity of 80% (95% CI 65–89%); specificity of 83% (95% CI 61–94%); positive predictive value of 91% (95% CI 75–98%) and negative predictive value of 65% (95% CI 43–83%). The overall accuracy was 81% (95% CI 69–89%). Conclusion: Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool.

Background Ureteric colic is a frequent presentation among surgical admissions in THP. It is commonly caused by urinary tract calculi. Low water intake, increased perspiration and stress are important risk factors for urolithiasis. Occupation has major impact on these factors. The present study was focused to assess the impact of occupation on urolithiasis. Method A descriptive cross sectional study was conducted enrolling 191 patients, admitted to the surgical unit THP from May 2014 to May 2015 with ueteric colic symptoms. In all, ureteric colic was confirmed by typical symptoms and other investigations, namely urine full report, X-ray Kidney Ureter Bladder (KUB) and Ultrasound KUB scans. Demographic details including occupation and investigation findings were recorded. Results There were 150 males (78.5%) and 41 females (21.5%), respectively in ratio of 3.6:1. Their mean age was 44 years. The majority (80.06%) of urolithiasis patients were outdoor workers. There were 2.88% senior officials, managers and professionals, 2.09% clerks, 7.8% sales, service workers and proprietors, 10.4% skilled agricultural and fishery workers, 18.76% craft and related workers, 23% plant and machine operators and assemblers, 18.3% elementary workers and 16.2% armed forces. When compared with the occupational distribution of general Sri Lankan population given by Central Bank annual Report 2014, there were excess percentages of armed forces, elementary workers and craft related workers in urolithiasis patient population. Conclusions Outdoor workers, mainly armed forces, manual laborers and drivers, who produced higher amount of perspiration have restricted water intake and more stress, have higher occupational risk of urolithiasis. Focused preventive methods should be planned.

Commentary on: Pickard R, Starr K, MacLennan G, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386:341–9.[OpenUrl][1][CrossRef][2][PubMed][3] Ureteral stones are a common painful condition often requiring medical care, although treatment is usually symptomatic as most stones pass within 6 weeks.1 ,2 Failed expectant management, obstruction and infection are the most common reasons for intervention. Therapies that facilitate stone passage will thereby reduce the symptom duration, need for intervention and probability of complications. Ureteric smooth muscle relaxants have been studied as potential medical expulsive therapies (MET) and the most recent systematic review advocates their use. However, the high risks of selection, allocation and ascertainment bias in the included trials and the inexplicit and subjective primary outcome resulted in high heterogeneity.3 This … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.volume%253D386%26rft.spage%253D341%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252815%252960933-3%26rft_id%253Dinfo%253Apmid%252F25998582%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(15)60933-3&link_type=DOI [3]: /lookup/external-ref?access_num=25998582&link_type=MED&atom=%2Febmed%2F20%2F5%2F171.atom

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.

Objective: To develop a cost-effective plan for the accurate diagnosis of urinary stone patients presenting with ureteric colic based on an assortment of investigations which are less invasive and more economical than intravenous urography (IVU). Patients and Methods: 143 consecutive emergency patients presenting with ureteric colic were admitted to hospital and prospectively studied by history recording, physical examination, laboratory tests and imaging procedures according to a preset format. Significant association of the final diagnosis of urinary stones (which was made by actual stone retrieval) with various diagnostic variables obtained from the results of investigation (including IVU) was statistically studied using bivariate correlation and multivariate logistic regression analysis. Algorithms for reaching an accurate diagnosis of urinary tract stones were formulated using the most significant diagnostic variables and the accuracy of each of those plans was compared with that of emergency IVU. Results: 18 patients were excluded for various reasons. Of the remaining 125 patients 82 (66%) were confirmed as having urinary stones. A positive IVU had the strongest correlation with the final diagnosis of urinary tract stones. Other findings associated with eventual stone retrieval in a descending order of significance were: calcular sonographic features; radio-opacities on a plain abdominal film of the kidney, ureter and bladder (KUB), and microhaematuria. Based on these findings two algorithms could be formulated to reach as accurate a diagnosis as possible. Algorithm A in which an initial ultrasound is mandatory had a sensitivity of 89%, a specificity of 88% and an overall accuracy of 88% for urinary stone detection compared with 91, 77, and 86%, respectively, for algorithm B in which ultrasonography was employed selectively after initial KUB and urinalysis for microhaematuria. This compares with 94, 79, and 89%, respectively, for IVU. Conclusion: Both plans are viable alternatives which could replace routine emergency 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.

Imaging is required in only a minority of patients with urinary tract infection. Some patients who present with severe loin pain are imaged because ureteric colic is suspected. If urinary tract infection does not respond normally to antibiotics, imaging is undertaken to check for evidence of renal obstruction or sepsis. Finally, after the acute infection has been treated, imaging is required in some patients to check for factors pre-disposing to renal damage or to relapsing or recurrent infection. This review discusses the appropriate choice of imaging technique to use in each clinical situation and summarises the expected findings.

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.

Summary— This study reviews 6 patients who were referred with severe loin pain radiating to the groin and in whom a presumptive diagnosis of ureteric colic was made. Of these, 3 patients were found to have carcinoma of the pancreas and the remaining 3 had retroperitoneal lymph node metastases. Retroperitoneal malignancies rarely present with loin pain, but this diagnosis should be considered in patients with long-standing loin pain in whom an obvious diagnosis is not apparent.

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.

The patients that you will be asked to see in the Accident and Emergency Department will be categorised eventually in accordance with a variety of diagnoses, but almost without exception the reason they are seeking emergency medical attention is because they are in pain, often severe pain. The pain of a ureteric colic, of a bladder stretched to twice its comfortable capacity or of an ischaemic testis is extreme and is usually compounded by apprehension, by fear and by a knowledge that there is nothing that the patient can do about it and that he or she must therefore rely on others.

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.

A 69-year-old man with a history of medullary sponge kidney presented with left sided ureteric colic. An intravenous urogram (IVU) failed to adequately demonstrate the left lower pole calyces and therefore a retrograde examination was performed (Fig. 1). A filling defect within the pelvi-calyceal system was present throughout the fluoroscopic examination. Urine cytolog2r was reported as suspicious for malignancy. A CT confirmed the presence of a filling defect which was not a stone. A left nephroureterectomy was therefore performed.

The nonsteroidal antiinflammatory drugs are among the most widely prescribed and used drugs in the community for rheumatologic as well as nonrheumatologic conditions, which include acute and chronic pain; biliary, ureteric colic; dysmenorrhoea; fever; and other applications that derive from the suppression of prostaglandin synthesis. Almost all nonsteroidal antiinflammatory drugs irritate gastric mucosa and enhance ulceration by blocking protective action of the prostaglandins on gastric mucosa, causing ulcer formation not only in stomach but also in lower part of oesophagus and in duodenum too. This review focuses on the adverse effects of nonsteroidal antiinflammatory drugs, severity of these adverse effects and attempts made to reduce the side effects through the concomitant use of other drugs.

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.