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Diagnostik und Therapie der Harnleitersteinkolik

Diagnosis and therapy of acute ureteral colic

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Summary

Acute ureteral colic presents with a complex of acute and characteristic flank pain that usually indicates the presence of a stone in the urinary tract. Diagnosis and management of renal colic have undergone considerable evolution and advancement in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected ureteral colic is one major advance in the primary diagnostic process. The superior sensitivity and specificity of helical CT allow ureterolithiasis to be diagnosed without the potential side effects of contrast media. Initial management is based on three key concepts: (A) rational and fast diagnostic process (B) effective pain control (C) and understanding of the impact of stone location and size on the natural course of the disease and definitive urologic management. These concepts are discussed in this review with reference to contemporary literature.

Zusammenfassung

Die akute Harnleiterkolik präsentiert sich mit charakteristischen, kolikartigen Flankenschmerzen. Diese sind in der Regel für ein Konkrement im Bereich der ableitenden Harnwege hinweisend. Diagnostik und Therapie der Ureterkolik haben in den letzten Jahren eine intensive Veränderung und Weiterentwicklung erfahren. Eine große Verbesserung in der Primärdiagnostik stellt die Anwendung der Nativcomputertomographie dar. Durch überlegene Sensitivität und Spezifität dieser Technik ist die schnelle und definitive Diagnostik möglich. Potentielle Nebenwirkungen des Kontrastmittels sind hierbei ausgeschlossen. Das Management einer Harnleiterkolik basiert auf den drei Säulen (A) rationale und schnelle Diagnostik, (B) effektive Schmerzbekämpfung und (C) Kenntnisse über den natürlichen Krankheitsverlauf sowie die definitive urologische Therapie aufgrund der Konkrementgröße und Lokalisation. Diese Konzepte werden in dieser Arbeit mit Bezug auf aktuelle Literatur diskutiert.

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Literatur

  • Hesse A, Brandle E, Wilbert D, Kohrmann KU, Alken P (2003) Study on the prevalence and incidence of urolithiasis in germany comparing the years 1979 vs. 2000. Eur Urol 44 (6): 709–713

    Article  PubMed  CAS  Google Scholar 

  • Clark JY, Thomson IM, Optenberg SA (1995) Economic impact of urolithiasis in the united states. J Urol 154 (6): 2020–2024

    Article  PubMed  CAS  Google Scholar 

  • Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, et al (2007) 2007 Guideline for the management of ureteral calculi. Eur Urol 52 (6): 1610–1631

    Article  PubMed  Google Scholar 

  • Press SM, Smith AD (1995) Incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain. Urology 45 (5): 753–757

    Article  PubMed  CAS  Google Scholar 

  • Miller OF, Rineer SK, Reichard SR, Buckley RG, Donovan MS, Graham IR, et al (1998) Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 52 (6): 982–987

    Article  PubMed  CAS  Google Scholar 

  • Pfister SA, Deckart A, Laschke S, Dellas S, Otto U, Buitrago C, et al (2003) Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. Eur Radiol 13 (11): 2513–2520

    Article  PubMed  CAS  Google Scholar 

  • Tisdale BE, Siemens DR, Lysack J, Nolan RL, Wilson JW (2007) Correlation of ct scan versus plain radiography for measuring urinary stone dimensions. Can J Urol 14 (2): 3489–3492

    PubMed  Google Scholar 

  • Heidenreich A, Desgrandschamps F, Terrier F (2002) Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol 41 (4): 351–362

    Article  PubMed  Google Scholar 

  • Ege G, Akman H, Kuzucu K, Yildiz S (2003) Acute ureterolithiasis: incidence of secondary signs on unenhanced helical ct and influence on patient management. Clin Radiol 58 (12): 990–994

    Article  PubMed  CAS  Google Scholar 

  • Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD (2007) Low-dose versus standard-dose ct protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol 188 (4): 927–933

    Article  PubMed  Google Scholar 

  • Eikefjord EN, Thorsen F, Rorvik J (2007) Comparison of effective radiation doses in patients undergoing unenhanced mdct and excretory urography for acute flank pain. AJR Am J Roentgenol 188 (4): 934–939

    Article  PubMed  Google Scholar 

  • Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, et al (2006) Does ultra-low-dose ct with a radiation dose equivalent to that of kub suffice to detect renal and ureteral calculi? J Comput Assist Tomogr 30(1): 44–50

    Article  PubMed  Google Scholar 

  • Mulkens TH, Daineffe S, De Wijngaert R, Bellinck P, Leonard A, Smet G, et al (2007) Urinary stone disease: comparison of standard-dose and low-dose with 4d mdct tube current modulation. AJR Am J Roentgenol 188 (2): 553–562

    Article  PubMed  Google Scholar 

  • Thoeny HC, Tuma J, Hess B (2003) Diagnostic imaging of calculi in the upper urinary tract – sonography vs. computerized tomography. Ther Umsch 60 (2): 73–78

    Article  PubMed  CAS  Google Scholar 

  • Sheafor DH, Hertzberg BS, Freed KS, Carroll BA, Keogan MT, Paulson EK, et al (2000) Nonenhanced helical ct and us in the emergency evaluation of patients with renal colic: prospective comparison. Radiology 217 (3): 792–797

    PubMed  CAS  Google Scholar 

  • Mutgi A, Williams JW, Nettleman M (1991) Renal colic. Utility of the plain abdominal roentgenogram. Arch Intern Med 151 (8): 1589–1592

    Article  PubMed  CAS  Google Scholar 

  • Patlas M, Farkas A, Fisher D, Zaghal I, Hadas-Halpern I (2001) Ultrasound vs ct for the detection of ureteric stones in patients with renal colic. Br J Radiol 74 (886): 901–904

    PubMed  CAS  Google Scholar 

  • Mitterberger M, Pinggera GM, Pallwein L, Gradl J, Feuchtner G, Plattner R, et al (2007) Plain abdominal radiography with transabdominal native tissue harmonic imaging ultrasonography vs unenhanced computed tomography in renal colic. BJU Int 100 (4): 887–890

    Article  PubMed  Google Scholar 

  • Kobayashi T, Nishizawa K, Watanabe J, Ogura K (2003) Clinical characteristics of ureteral calculi detected by nonenhanced computerized tomography after unclear results of plain radiography and ultrasonography. J Urol 170 (3): 799–802

    Article  PubMed  Google Scholar 

  • Moody TE, Vaughn EDJ, Gillenwater JY (1975) Relationship between renal blood flow and ureteral pressure during 18 hours of total unilateral uretheral occlusion. Implications for changing sites of increased renal resistance. Invest Urol 13 (3): 246–251

    PubMed  CAS  Google Scholar 

  • Travaglini F, Bartoletti R, Gacci M, Rizzo M (2004) Pathophysiology of reno-ureteral colic. Urol Int 72 [Suppl 1]: 20–23

    Article  PubMed  Google Scholar 

  • Labrecque M, Dostaler LP, Rousselle R, Nguyen T, Poirier S (1994) Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic. A meta-analysis. Arch Intern Med 154 (12): 1381–1387

    Article  PubMed  CAS  Google Scholar 

  • Holdgate A, Pollock T (2005) Nonsteroidal anti-inflammatory drugs (Nsaids) versus opioids for acute renal colic. Cochrane Database Syst Rev (2): CD004137

  • Collaborative Group of the Spanish Society of Clinical Pharmacology (1991) Comparative study of the efficacy of dipyrone, diclofenac sodium and pethidine in acute renal colic. Eur J Clin Pharmacol 40 (6): 543–546

    Google Scholar 

  • O'Connor A, Schug SA, Cardwell H (2000) A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med 17 (4): 261–264

    PubMed  Google Scholar 

  • Cordell WH, Larson TA, Lingeman JE, Nelson DR, Woods JR, Burns LB, et al (1994) Indomethacin Suppositories Versus Intravenously Titrated Morphine for the Treatment of Ureteral Colic. Ann Emerg Med 23 (2): 262–269

    Article  PubMed  CAS  Google Scholar 

  • Supervia A, Pedro-Botet J, Nogues X, Echarte JL, Minguez S, Iglesias ML, et al (1998) Piroxicam fast-dissolving dosage form vs diclofenac sodium in the treatment of acute renal colic: A Double-Blind Controlled Trial. Br J Urol 81 (1): 27–30

    PubMed  CAS  Google Scholar 

  • Nissen I, Birke H, Olsen JB, Wurtz E, Lorentzen K, Salomon H, et al (1990) Treatment of ureteric colic. Intravenous versus rectal administration of indomethacin. Br J Urol 65 (6): 576–579

    PubMed  CAS  Google Scholar 

  • Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M (2001) Guidelines on urolithiasis. Eur Urol 40 (4): 362–371

    Article  PubMed  CAS  Google Scholar 

  • Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA, et al (1998) Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 160 (4): 1260–1264

    Article  PubMed  CAS  Google Scholar 

  • Mokhmalji H, Braun PM, Martinez Portillo FJ, Siegsmund M, Alken P, Kohrmann KU (2001) Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: a prospective, randomized clinical trial. J Urol 165 (4): 1088–1092

    Article  PubMed  CAS  Google Scholar 

  • Joshi HB, Obadeyi OO, Rao PN (1999) A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones. BJU Int 84 (3): 264–269

    Article  PubMed  CAS  Google Scholar 

  • Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al (1997) Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 158 (5): 1915–1921

    Article  PubMed  CAS  Google Scholar 

  • Miller OF, Kane CJ (1999) Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162 (3 Pt 1): 688–90; discussion 690–691

    Article  PubMed  CAS  Google Scholar 

  • Holm-Nielsen A, Jorgensen T, Mogensen P, Fogh J (1981) The prognostic value of probe renography in ureteric stone obstruction. Br J Urol 53 (6): 504–507

    Article  PubMed  CAS  Google Scholar 

  • Irving SO, Calleja R, Lee F, Bullock KN, Wraight P, Doble A (2000) Is the conservative management of ureteric calculi of > 4 mm safe? BJU Int 85 (6): 637–640

    Article  PubMed  CAS  Google Scholar 

  • Laerum E, Ommundsen OE, Gronseth JE, Christiansen A, Fagertun HE (1995) Oral diclofenac in the prophylactic treatment of recurrent renal colic. A double-blind comparison with placebo. Eur Urol 28 (2): 108–111

    PubMed  CAS  Google Scholar 

  • Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, et al (2006) Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 368 (9542): 1171–1179

    Article  PubMed  Google Scholar 

  • Parsons JK, Hergan LA, Sakamoto K, Lakin C (2007) Efficacy of alpha-blockers for the treatment of ureteral stones. J Urol 177 (3): 983–987; discussion 987

    Article  PubMed  CAS  Google Scholar 

  • Pace KT, Weir MJ, Tariq N, Honey RJ (2000) Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment. J Urol 164 (6): 1905–1907

    Article  PubMed  CAS  Google Scholar 

  • Strohmaier WL, Schubert G, Rosenkranz T, Weigl A (1999) Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: A prospective study. Eur Urol 36 (5): 376–379

    Article  PubMed  CAS  Google Scholar 

  • Kupeli B, Biri H, Isen K, Onaran M, Alkibay T, Karaoglan U, et al (1998) Treatment of ureteral stones: Comparison of extracorporeal shock wave lithotripsy and endourologic alternatives. Eur Urol 34 (6): 474–479

    Article  PubMed  CAS  Google Scholar 

  • Nabi G, Downey P, Keeley F, Watson G, McClinton S (2007) Extra-corporeal shock wave lithotripsy (eswl) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev (1): CD006029

  • Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: Holmium: Yag laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167 (5): 1972–1976

    Article  PubMed  Google Scholar 

  • Kupeli B, Alkibay T, Sinik Z, Karaoglan U, Bozkirli I (2000) What is the optimal treatment for lower ureteral stones larger than 1 cm? Int J Urol 7 (5): 167–171

    Article  PubMed  CAS  Google Scholar 

  • Knoll T, Wendt-Nordahl G, Alken P (2005) Clinical value of percutaneous nephrolithotomy. Urologe A 44 (3): 299–306; quiz 307–308

    Article  PubMed  CAS  Google Scholar 

  • Kumar V, Ahlawat R, Banjeree GK, Bhaduria RP, Elhence A, Bhandari M (1996) Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi. Arch Esp Urol 49 (1): 86–91

    PubMed  CAS  Google Scholar 

  • Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP (2005) Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 19 (1): 54–57

    Article  PubMed  Google Scholar 

  • Karami H, Arbab AH, Hosseini SJ, Razzaghi MR, Simaei NR (2006) Impacted upper-ureteral calculi >1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach? J Endourol 20 (9): 616–619

    Article  PubMed  Google Scholar 

  • Borboroglu PG, Amling CL, Schenkman NS, Monga M, Ward JF, Piper NY, et al (2001) Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol 166 (5): 1651–1657

    Article  PubMed  CAS  Google Scholar 

  • Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, D'A Honey RJ (2001) A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 165 (5): 1419–1422

    Article  PubMed  CAS  Google Scholar 

  • Skrepetis K, Doumas K, Siafakas I, Lykourinas M (2001) Laparoscopic versus open ureterolithotomy. A comparative study. Eur Urol 40 (1): 32–36; discussion 37

    Article  PubMed  CAS  Google Scholar 

  • Goel A, Hemal AK (2001) Upper and mid-ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy. BJU Int 88 (7): 679–682

    Article  PubMed  CAS  Google Scholar 

  • Ather MH, Paryani J, Memon A, Sulaiman MN (2001) A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention – is there a role for open surgery? BJU Int 88 (3): 173–177

    Article  PubMed  CAS  Google Scholar 

  • Muslumanoglu AY, Karadag MA, Tefekli AH, Altunrende F, Tok A, Berberoglu Y (2006) When is open ureterolithotomy indicated for the treatment of ureteral stones? Int J Urol 13 (11): 1385–1388

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Urologische Klinik, Solothurner Spitäler AG (soH), Switzerland

    Thomas H. Forster

  2. Urologische Universitätsklinik beider Basel, Switzerland

    Thomas H. Forster, Gernot Bonkat, Stephen Wyler, Robin Ruszat, Nicole Ebinger, Thomas C. Gasser & Alexander Bachmann

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  1. Thomas H. Forster
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  2. Gernot Bonkat
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  3. Stephen Wyler
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  4. Robin Ruszat
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  6. Thomas C. Gasser
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  7. Alexander Bachmann
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Correspondence to Thomas H. Forster.

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Forster, T., Bonkat, G., Wyler, S. et al. Diagnostik und Therapie der Harnleitersteinkolik. Wien Klin Wochenschr 120, 325–334 (2008). https://doi.org/10.1007/s00508-008-0988-3

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