pituitrin and Ureteral-Calculi

In 85% of patients, renal colic is caused by renal-ureteral stones with extrinsic obstructions such as pelvic, retroperitoneal or intestinal abnormalities, and intrinsic reno-ureteral obstructions, e.g. junction pathologies and malformation, accounting for only 10 and 5%, respectively. The objectives of therapy for renal colic therapy are to eliminate pain, preserve renal function and eliminate the obstruction by the excretory pathway. Many drugs can be used to relieve pain: non-steroid anti-inflammatory agents (NSAIDs), opioid analgesics, antidiuretic hormone (ADH), loco-regional anesthesia and acupuncture. Opiates are the first-choice therapy during pregnancy as no other drug is indicated because of tetragenic potential. Paracetamol (N-acetyl-p-aminophenol) is the only NSAID that is registered for pediatric use because it has none of the adverse side effects that are associated with NSAIDs. Tamsulosin, an alpha-lithic drug, has very recently been included among the drugs that are used for stone expulsion. The rationale underlying its use is that a high concentration of alpha-1D adrenergic receptors has been recently detected in the terminal ureter, especially in the intramural tract. Inhibition of alpha-1D receptor stimulation should relax smooth muscle in the intramural ureteral tract, making stone expulsion easier.

Topics: Acute Disease; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Kidney Calculi; Male; Pain Measurement; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ureteral Calculi; Vasopressins

Topics: Aged; Diuresis; Drainage; Humans; Infant; Kidney; Male; Middle Aged; Natriuresis; Polyuria; Postoperative Complications; Prostatic Hyperplasia; Prostatic Neoplasms; Ureteral Calculi; Ureteral Obstruction; Urinary Bladder Neck Obstruction; Urologic Diseases; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Aged; Female; Humans; Indomethacin; Male; Middle Aged; Osmolar Concentration; Pain; Ureteral Calculi; Vasopressins; Water-Electrolyte Balance

We treated 25 patients with ureteral colic and urographically verified stones with 50 mg. indomethacin intravenously. Pain was relieved completely in 17 patients, while in 8 incomplete or no pain relief was achieved after the infusion of indomethacin. Patients completely relieved of pain had significantly higher levels of antidiuretic hormone in plasma before the infusion of indomethacin (18.2 plus or minus 3.4 pg./ml.) than patients with incomplete or no pain relief (7.2 plus or minus 1.3 pg./ml.) (p less than 0.01). These findings indicate that the volume status and/or the level of antidiuretic hormone may be of critical importance for pain relief after infusion of indomethacin in patients with ureteral colic.

Topics: Adult; Aged; Colic; Female; Humans; Indomethacin; Male; Middle Aged; Ureteral Calculi; Ureteral Diseases; Vasopressins