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Ureteral Pain

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Abstract

Visceral pain is usually a vague and discomfort such as deep, squeezing, or colicky. Visceral pain comes from deep organs of the thorax, abdomen, or pelvis, is not as well localized as somatic pain.

Ureteral pain, which is a visceral pain, is a common problem and ureteric colic is one of the most intense pain conditions in clinic admissions. Pain relief is difficult and often leads to medical attention. Mechanoreceptors stimulated by pressure increase and chemoreceptors activated by ischemia or inflammation are the sensory receptors involved in the formation of this pain. Imaging methods play an important role to arrive at a correct diagnosis, and opiates, non-steroidal anti-inflammatory drugs, alpha-adrenergic blockers, calcium channel blockers and glucocorticoids are the approaches used to relieve ureteral pain.

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References

Ureteral Pain

  1. Pedersen KV, Drewes AM, Frimodt-Møller PC, Osther PJ. Visceral pain originating from the upper urinary tract. Urol Res. 2010;38(5):345–55.

    Article  PubMed  Google Scholar 

  2. Cervero F, Laird JM. Visceral pain. Lancet. 1999;353(9170):2145–8.

    Article  CAS  PubMed  Google Scholar 

  3. Drewes AM. Visceral smerte. In: Jensen TS, Dahl JB, Arendt-Nielsen L, editors. Smerter–en lærebog. Copenhagen: Fadl’s Forlag A/s; 2003. p. 153–69.

    Google Scholar 

  4. Arendt-Nielsen L, Laursen RJ, Drewes AM. Referred pain as an indicator for neural plasticity. Prog Brain Res. 2000;129:343–56.

    Article  CAS  PubMed  Google Scholar 

  5. Chernigovskii VN, Musiashichikova SS. Representation of afferent visceral systems in cerebral cortex in the cat. J Neurophysiol. 1966;29(3):565–82.

    Article  CAS  PubMed  Google Scholar 

  6. Ohara S, Lenz FA. Medial lateral extent of thermal and pain sensations evoked by microstimulation in somatic sensory nuclei of human thalamus. J Neurophysiol. 2003;90(4):2367–77.

    Article  PubMed  Google Scholar 

  7. Gebhart GF, Bielefeldt K. Physiology of visceral pain. Compr Physiol. 2016;6(4):1609–33.

    Article  CAS  PubMed  Google Scholar 

  8. Ammons WS. Primate spinothalamic cell responses to ureteral occlusion. Brain Res. 1989;496(1–2):124–30.

    Article  CAS  PubMed  Google Scholar 

  9. Ammons WS. Responses of spinoreticular cells to graded increases in renal venous pressure. Am J Phys. 1991;260(1 Pt 2):R27–31.

    CAS  Google Scholar 

  10. Ammons WS. Bowditch lecture. Renal afferent inputs to ascending spinal pathways. Am J Phys. 1992;262(2 Pt 2):R165–76.

    CAS  Google Scholar 

  11. Vizzard MA, Standish A, Ammons WS. Effects of renal receptor stimulation on neurons within the ventrolateral medulla of the cat. Am J Phys. 1993;265(2 Pt 2):R290–301.

    CAS  Google Scholar 

  12. Standish A, Vizzard MA, Ammons WS. Tonic descending modulation of spinal neuronal responses to activation of renal receptors. Am J Phys. 1993;265(6 Pt 2):R1291–303.

    CAS  Google Scholar 

  13. Sengupta JN, Gebhart GF. Mechanosensitive afferent fibers in the gastrointestinal and lower urinary tract. In: Gebhart GF, editor. Visceral pain. Progress in pain research and management; 1995. p. 75–98.

    Google Scholar 

  14. Soriano RM, Penfold D, Leslie SW. Anatomy. Kidneys: Abdomen and Pelvis; 2021.

    Google Scholar 

  15. Di Benedetto A, Arena S, Nicotina PA, Mucciardi G, Galì A, Magno C. Pacemakers in the upper urinary tract. Neurourol Urodyn. 2013;32(4):349–53.

    Article  PubMed  Google Scholar 

  16. Kuntz A. The autonomic nervous system. Philadelphia: Lea & Febiger; 1953.

    Google Scholar 

  17. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athl Train. 2000;35(3):248–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Mitchell GA. The innervation of the kidney, ureter, testicle and epididymis. J Anat. 1935;70(Pt 1):10–32. 15

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Lescay HA, Jiang J, Tuma F. Anatomy, abdomen and pelvis, ureter. In: StatPearls [internet]. Treasure Island (FL): StatPearls; 2021.

    Google Scholar 

  20. Patti L, Leslie SW. Acute Renal Colic. In: StatPearls [internet]. Treasure Island (FL): StatPearls Publishing; 2021. p. 2021.

    Google Scholar 

  21. Zwergel U, Zwergel T, Ziegler M. Effects of prostaglandins and prostaglandin synthetase inhibitors on acutely obstructed kidneys in the dog. Urol Int. 1991;47(2):64–9.

    Article  CAS  PubMed  Google Scholar 

A. Ureteral Colic

  1. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, McPherson G, McDonald A, Anson K, N’Dow J, Burgess N, Clark T, Kilonzo M, Gillies K, Shearer K, Boachie C, Cameron S, Norrie J, McClinton S. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015;386(9991):341–9.

    Article  PubMed  Google Scholar 

  2. Kiil F. The function of the ureter and renal pelvis. Philadelphia: WB Saunders Co.; 1957.

    Google Scholar 

  3. Bretland PM. Acute ureteric obstruction-clinical and radiological aspects. Proc R Soc Med. 1974;67(12 Pt 1):1215–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Michaelson G. Percutaneous puncture of the renal pelvis, intrapelvic pressure and the concentrating capacity of the kidney in hydronephrosis. Acta Med Scand. 1974;559:1.

    CAS  Google Scholar 

Incidence

  1. Pearle MS, Calhoun EA, Curhan GC. Urologic diseases in America project: urolithiasis. J Urol. 2005;173:848–57.

    Article  PubMed  Google Scholar 

  2. Worster AS, Bhanich SW. Fluids and diuretics for acute ureteric colic. Cochrane Database Syst Rev. 2012;2:CD004926.

    Google Scholar 

Pathophysiology

  1. Struthers NW, Constantinou CE. Ureteric physiology. Curr Opin Urol. 1992;2:310–3.

    Article  Google Scholar 

  2. Travaglini F, Bartoletti R, Gacci M, Rizzo M. Pathophysiology of Reno-ureteral colic. Urol Int. 2004;72(suppl 1):20–3.

    Article  PubMed  Google Scholar 

  3. Shokeir AA. Renal colic: pathophysiology, diagnosis and treatment. Eur Urol. 2001;39:241–9.

    Article  CAS  PubMed  Google Scholar 

Location

  1. DeWolf WC, Fraley EE. Renal pain. Urology. 1975;6(4):403–8.

    Article  CAS  PubMed  Google Scholar 

  2. McAninch JW. Chapter 3. Symptoms of disorders of the genitourinary tract. In: JW MA, Lue TF, editors. Smith and Tanagho’s general urology. 18th ed. McGraw Hill; 2013. Accessed 30 Oct 2021.

    Google Scholar 

Diagnosis

  1. Masarani M, Dinneen M. Ureteric colic: new trends in diagnosis and treatment. Postgrad Med J. 2007;83(981):469–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Denton ER, Mackenzie A, Greenwell T, Popert R, Rankin SC. Unenhanced helical CT for renal colic is the radiation dose justifiable? Clin Radiol. 1999;54(7):444–7.

    Article  CAS  PubMed  Google Scholar 

  3. Ripollés T, Errando J, Agramunt M, Martínez MJ. Ureteral colic: US versus CT. Abdom Imaging. 2004;29(2):263–6.

    Article  PubMed  Google Scholar 

  4. Argyropoulos A, Farmakis A, Doumas K, Lykourinas M. The presence of microscopic hematuria detected by urine dipstick test in the evaluations of patients with renal colic. Urol Res. 2004;32:294–7.

    Article  CAS  PubMed  Google Scholar 

  5. Jung SI, Kim YJ, Park HS, Jeon HJ, Park HK, Paick SH, Kim HG, Lho YS. Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location. J Comput Assist Tomogr. 2010;34(6):879–82.

    Article  PubMed  Google Scholar 

  6. Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol. 2013;189(4):1203–13.

    Article  PubMed  Google Scholar 

  7. Wong C, Teitge B, Ross M, Young P, Robertson HL, Lang E. The accuracy and prognostic value of point-of-care ultrasound for nephrolithiasis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2018;25(6):684–98.

    Article  PubMed  Google Scholar 

  8. Skolarikos A, Straub M, Knoll T, Sarica K, Seitz C, Petřík A, Türk C. Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines. Eur Urol. 2015;67(4):750–63.

    Article  PubMed  Google Scholar 

  9. Yilmaz S, Sindel T, Arslan G, Ozkaynak C, Karaali K, Kabaalioğlu A, Lüleci E. Renal colic:comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol. 1998;8(2):212–7.

    Article  CAS  PubMed  Google Scholar 

  10. Ripollés T, Martínez-Pérez MJ, Vizuete J, Miralles S, Delgado F, Pastor-Navarro T. Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact. Abdom Imaging. 2013;38(4):863–9.

    Article  PubMed  Google Scholar 

Treatment

  1. Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev. 2015;6:CD006027.

    Google Scholar 

  2. Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D’Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med. 2006;48(2):173–81.

    Article  PubMed  Google Scholar 

  3. Tramèr MR, Williams JE, Carroll D, Wiffen PJ, Moore RA, McQuay HJ. Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesthesiol Scand. 1998;42(1):71–9.

    Article  PubMed  Google Scholar 

  4. Laerum E, Ommundsen OE, Grønseth JE, Christiansen A, Fagertun HE. Oral diclofenac in the prophylactic treatment of recurrent renal colic. A double-blind comparison with placebo. Eur Urol. 1995;28(2):108–11.

    Article  CAS  PubMed  Google Scholar 

  5. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C, Lamberts M, Bjerring Olesen J, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011;123(20):2226–35.

    Article  CAS  PubMed  Google Scholar 

  6. Fosbøl EL, Gislason GH, Jacobsen S, Folke F, Hansen ML, Schramm TK, Sørensen R, Rasmussen JN, Andersen SS, Abildstrom SZ, Traerup J, Poulsen HE, Rasmussen S, Køber L, Torp-Pedersen C. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study. Clin Pharmacol Ther. 2009;85(2):190–7.

    Article  PubMed  Google Scholar 

  7. Pathan SA, Mitra B, Cameron PA. A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. Eur Urol. 2018;73(4):583–95.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Mastrangelo D, Wisard M, Rohner S, Leisinger H, Iselin CE. Diclofenac and NS-398, a selective cyclooxygenase-2 inhibitor, decrease agonist-induced contractions of the pig isolated ureter. Urol Res. 2000;28(6):376–82.

    Article  CAS  PubMed  Google Scholar 

  10. Phillips E, Hinck B, Pedro R, Makhlouf A, Kriedberg C, Hendlin K, et al. Celecoxib in the management of acute renal colic: a randomized controlled clinical trial. Urology. 2009;74(5):994–9.

    Article  PubMed  Google Scholar 

  11. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol. 2005;174(1):167–72.

    Article  CAS  PubMed  Google Scholar 

  12. Amer T, Osman B, Johnstone A, Mariappan M, Gupta A, Brattis N, Jones G, Somani BK, Keeley FX Jr, Aboumarzouk OM. Medical expulsive therapy for ureteric stones: analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab J Urol. 2017;15(2):83–93.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Somani BK, Aboumarzouk O, Traxer O, Baard J, Kamphuis G, de la Rosette J. Medical expulsive therapy for ureteral stones: where do we go from here? Nat Rev Urol. 2016;13(10):608–12.

    Article  PubMed  Google Scholar 

  14. Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, Chen L, Cheng Y, Yang J, Mi Q, Zhang Y, Chen Z, Guo H, He W, Chen Z. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int. 2011;108(2):276–9.

    Article  CAS  PubMed  Google Scholar 

  15. Bandi G, Wilkinson EA, Cary-Coyle TL, Jerde TJ, Nakada SY. Third prize: effect of hydrocortisone on porcine ureteral contractility in vitro. J Endourol. 2008;22(6):1169–73.

    Article  PubMed  Google Scholar 

  16. Saita A, Bonaccorsi A, Marchese F, Condorelli SV, Motta M. Our experience with nifedipine and prednisolone as expulsive therapy for ureteral stones. Urol Int. 2004;72:43–5.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, Istinye Universtiy Faculty of Medicine, Istanbul, Turkey

    Yasin Yitgin

  2. Department of Urology, Biruni University, Medical School, Istanbul, Turkey

    Kemal Sarica

Authors
  1. Yasin Yitgin
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  2. Kemal Sarica
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Editor information

Editors and Affiliations

  1. Belqas, Elnagar Urology Center, Mansoura City, Egypt

    Mahmoud Abdel-Gawad

  2. Urology Department, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Bedeir Ali-El-Dein

  3. Department of Urology and Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    John Barry

  4. Department of Urology, Universitatsklinikum Tubingen, Tübingen, Baden-Württemberg, Germany

    Arnulf Stenzl

Questions

Questions

  1. 1.

    What are the differences between visceral pain and somatic pain?

    1. (a)

      Origin

    2. (b)

      Localized

    3. (c)

      autonomic reflexes accompany

    4. (d)

      underlying mechanism

    5. (e)

      All of them

  1. 2.

    Which plexuses provide the autonomic nerve supply of the ureter?

    1. (a)

      ninth thoracic and tenth thoracic

    2. (b)

      10th and 11th thoracic

    3. (c)

      12th thoracic

    4. (d)

      first and second lumbar

    5. (e)

      B and D

  1. 3.

    In which part of the kidney are chemoreceptors concentrated?

    1. (a)

      Gerota’s fascia

    2. (b)

      Renal capsule

    3. (c)

      Renal pelvic wall

    4. (d)

      Renal vascular system

    5. (e)

      C and D

  1. 4.

    What is the prevalence of the ureteral colic?

    1. (a)

      15–20%

    2. (b)

      20–25%

    3. (c)

      1–5%

    4. (d)

      25–30%.

    5. (e)

      5–15%

  1. 5.

    In which segment is the possible ureteral obstruction in a patient who presents urgently with symptoms of bladder irritability and suprapubic pain in addition to ureteric colic?

    1. (a)

      Renal pelvis

    2. (b)

      Proximal ureter

    3. (c)

      Mid ureter

    4. (d)

      B and C

    5. (e)

      Distal ureter

Competing Interests

None

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Yitgin, Y., Sarica, K. (2023). Ureteral Pain. In: Abdel-Gawad, M., Ali-El-Dein, B., Barry, J., Stenzl, A. (eds) The Ureter . Springer, Cham. https://doi.org/10.1007/978-3-031-36212-5_18

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  • DOI: https://doi.org/10.1007/978-3-031-36212-5_18

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