Urolithiasis


Partial or complete obstruction of the urinary tract by one or more calculi in adults.

Clinical features

– Acute, sometimes intense, flank or pelvic pain (renal colic).
– Haematuria, may be accompanied by the passage of a calculus.
– Secondary infections may develop: fever and signs of pyelonephritis.

Treatment

– Analgesics:

• For moderate pain (3-day treament)
paracetamol PO + ibuprofen  PO (see Pain, Chapter 1hyoscine butylbromide PO: 10 to 20 mg 3 times daily

• For renal colic
diclofenac IM: 75 mg one to 2 times daily for 2 days max. then change to oral treatment with ibuprofen PO (see Pain, Chapter 1)
+ hyoscine butylbromide IM: 10 to 20 mg every 8 hours

In the event of failure to respond or contra-indications: morphine IV (see Pain, Chapter 1).

– In patients with infection: antibiotic treatment as for pyelonephritis. The effectiveness will depend on the passage of the calculus.