Renal colic: pathophysiology, diagnosis and management

Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology [EAU] Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented. The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined. An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible

Endourology: a comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction

To compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction [UPJO] were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar [6.2 days] in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons