Enfrentamiento del cólico renal en urgencia / Confrontation of renal colic in urgency

Ureteral colic as a nosologic entity, is part of a select group of pathologies that present themselves in an intense and acute form, in which the patient suffers excruciating pain and demands quick diagnosis and treatment. It’s also a common disease in our emergency service, like in other countries. The aim of the present study is to standardize and deepen the management and treatment of ureteral colic, from the perspective of the emergency medicine...

Tratamiento del cólico nefrítico con diclofenaco sódico / Treatment of nephritic colic with diclofenac sodium

Introducción: habitualmente se utilizan como tratamiento para el cólico nefrítico los antiespasmódicos y relajantes de la fibra lisa muscular, pero desde los años 90 muchos estudios avalan el uso de los antiinflamatorios no esteroideos como mejor opción de tratamiento para el alivio sintomático del mismo.Objetivo: evaluar la efectividad del diclofenaco sódico en el tratamiento del cólico nefrítico.Métodos: se realizó un estudio observacional, descriptivo, de corte longitudinal, retrospectivo en 54 pacientes que asistieron al Servicio de Urgencia del Hospital General Docente Leopoldito Martínez, del municipio San José de las Lajas, Mayabeque por presentar cólico nefrítico y recibieron tratamiento con diclofenaco sódico, en el período comprendido de enero 2010 a febrero 2011. Resultados: el 57,4 por ciento de los pacientes se encontraban entre los 31 y 40 años de edad, el 83,3 por ciento pertenecieron al sexo masculino, en el 75,6 por ciento se comprobó hematuria microscópica en el parcial de orina y en el ultrasonido abdominal se constató litiasis renoureteral en el 62,5 por ciento y pielocaliectasia ligera en el 12,5 por ciento. la evolución del dolor en los pacientes se evaluó previo y posterior a la administración intramuscular de Diclofenaco sódico, a través de la Escala Visual Análoga (EVA). Donde se observó que en el mayor por ciento de los pacientes hubo una disminución significativa del dolor, cuyo promedio de tiempo de estancia en el hospital fue de 37,5 minutos después de administrado el medicamento.Conclusiones: el uso del diclofenaco sódico tiene una buena efectividad en el tratamiento del cólico nefrítico

Introduction: antispasmodics and relaxants of smooth muscle fiber are usually used as a treatment for nephritic colic, but since the 90's many studies support the use of nonsteroidal antiinflammatory drugs (NSAIDs) as best treatment option for the symptomatic relief of it.Objective: to assess the effectiveness of diclofenac sodium in the treatment of nephritic colic.Methods: an observational, descriptive, longitudinal, retrospective study was performed in 54 patients who attended the Emergency Service of Leopoldito Martinez General Teaching Hospital, in San José de las Lajas municipality, Mayabeque for exhibiting nephritic colic and who were treated with diclofenac sodium, in the period from January 2010 to February 2011. Results: 57,4 per cent of the patients were between 31 and 40 years old, 83,3 per cent were males, in 75,6 per cent it was found microscopic hematuria in partial urinalysis and in the abdominal ultrasound it was confirmed reno-ureteral lithiasis in 62,5 per cent and mild pyelocaliectasis in 12,5 per cent. The evolution of pain in patients was assessed prior and subsequent to intramuscular administration of diclofenac sodium through the Visual Analogue Scale (VAS). Where it was noted that in the highest percentage of patients there was a significant decrease in pain, whose average length of stay in hospital was 37,5 minutes after medication administration.Conclusions: the use of diclofenac sodium has good effectiveness in the treatment of nephritic colic

Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.