A quiet winter evening (or spring, summer, or autumn – whichever you prefer). You came home from work, had dinner, drank a glass of your favorite beer, and settled comfortably on the couch, focusing on watching TV. Suddenly you feel discomfort in the lumbar region, which gradually turns into a dull ache and then into sharp pain. You try to find a body position in which the pain will be less intense – zero effect. The pain does not subside, you begin rolling on the floor or the bed. You start shivering, weakness comes over you, nausea and vomiting appear – no relief. The abdomen swells like a drum, gas does not pass. Multiple painful urges to urinate occur. What is this?! Stale beer?! Fermented cabbage?! No, friends, this is renal colic! What is it? How is it? Why? What to do? Let’s figure it out.
What You Need to Know About Renal Colic
What is renal colic?
Renal colic is a collective term that includes several symptoms indicating impaired urine outflow. The pain that occurs in this condition is among the most intense and excruciating. It is almost impossible to endure, and the patient may even fall into shock. It is important to understand that the onset of pain is just a symptom, but a dangerous one for the patient’s health and life. As a rule, the occurrence of renal colic indicates urolithiasis and is at this moment associated with the migration of stones from the calyx or renal pelvis into the ureter.
The mechanism of renal colic
As a result of impaired urine outflow, intrarenal (more precisely, intrapelvic) pressure increases – figuratively speaking, the kidney swells like a balloon filled with water. The pressure of urine on the renal parenchyma leads to microcirculation disorders and edema. Altogether, this affects the sensory nerve receptors of the renal hilum and fibrous capsule, which have little potential for stretching, resulting in the characteristic pain attack.
Who is more at risk of renal colic
The incidence of renal colic in the general population ranges from 1–12%. Moreover, the majority of cases occur in men. It should be noted that 13% of all cases of renal colic are caused by other diseases of the kidneys and ureters (tumors, tuberculosis, hydronephrosis, ureteral-vascular conflict, retroperitoneal fibrosis) and are associated with the passage of blood clots, pus, or mucus blocking the urinary tract lumen.
Renal Colic. Causes
Renal colic never occurs “out of nowhere.” Behind every such episode lies a cause – most often a mechanical obstruction, inflammation, or spasm that interferes with the normal flow of urine. The body reacts instantly: pressure inside the kidney rises, its walls stretch, and the pain becomes almost unbearable. Below are the main causes that can lead to the development of renal colic.
1. Urolithiasis
The main cause of renal colic is a mechanical obstruction of the urinary tract, most commonly due to stones. When a stone blocks the flow of urine, pressure in the kidney increases sharply, leading to swelling, irritation of nerve endings, and sharp, “stabbing” pain. This condition can arise suddenly, catching a person off guard and feeling like a storm inside the body.
An attack often occurs after intense physical activity, driving on a bumpy road, or consuming large amounts of fluids or alcohol. Any sudden movement or overstretching of the urinary tract can “push” the stone and trigger colic.
2. Inflammatory Processes and Mucosal Edema
In acute inflammations (pyelonephritis, papillitis), the ureteral walls become more sensitive to pressure, and the mucosa swells, narrowing its lumen and hindering urine outflow. The accumulation of urine in the renal pelvis creates pressure on the kidney walls and causes a typical pain syndrome. Sometimes, colic occurs suddenly – as a reaction to inflammatory swelling, even in the absence of a stone.
3. Anatomical and Congenital Structural Abnormalities
Narrowing of the ureter, congenital bends, or vascular loops compressing the ureter from the outside can cause periodic pain. Such anomalies often manifest for the first time as renal colic, when urine outflow is disrupted during physical exertion or a change in body position.
4. Tumors and External Compression of the Ureter
Colic can be caused by a tumor of the kidney, ureter, or adjacent organs (ovaries, uterus, prostate). A growing mass compresses the ureter, creating an obstacle to urine outflow. The pain in such cases may be less sharp but gradually increasing, accompanied by a feeling of heaviness and fullness in the lower back.
5. Traumatic and Postoperative Changes
After pelvic surgeries, catheter placements, or past inflammations, scarring (strictures) of the ureter may develop. Such areas lose elasticity and can easily become blocked even by minor swelling or sand, causing a colic attack. Sometimes, pain appears months after the surgical procedure.
6. Spasm and Functional Disorders of the Ureters
The cause is not always mechanical. Sometimes, renal colic arises due to spasms of the ureteral walls. This can occur with hypothermia, stress, sudden physical strain, or reflexively – during inflammation of adjacent organs (cystitis, prostatitis). Such a spasm also causes an acute disruption of urine outflow and pain similar in sensation to that caused by a stone.
7. Systemic and Metabolic Disorders
Gout, dehydration, an excess of calcium, vitamin D, or protein-rich foods contribute to the formation of salt crystals that settle in the kidneys and gradually form stones. Metabolic disorders often create the background for the first episode of renal colic – as a warning sign of developing urolithiasis.
Renal Colic. Symptoms
When an attack starts suddenly, it is difficult to understand what is happening. In such cases, seven characteristic symptoms of renal colic become the main guide: their intensity and combination help confirm the diagnosis.
1. Constant or periodic pain in the kidney area, “stabbing pain” in the kidneys
Colic caused by kidney pathology is one of the strongest types of pain. The pain may radiate to the groin, genitals (scrotum, penis, vagina, and labia), and may worsen during urination. Pain sometimes lasts for several hours or even days, periodically subsiding. The pain is so intense that patients pace around the room, constantly changing position, which usually does not bring relief. Such characteristic behavior often allows diagnosis “from a distance.”
2. Partial or complete difficulty urinating and passing gas
When the urinary tract is obstructed by a stone, normal organ patency and tone are disrupted, leading to difficulty urinating, and in cases of severe spasm, intestinal function may also be affected, up to difficulty passing gas and bloating.
3. False urges to defecate and urinate
Irritation of nearby nerve endings and pelvic muscle spasm cause false and frequent urges: the person feels an urgent need to use the toilet, even though there may be no real necessity. This is a typical symptom when the pathology is located in the lower urinary tract.
4. Worsening general condition, chills, weakness
Severe pain and the possible onset of inflammation often cause general malaise: chills, weakness, pronounced fatigue, and reduced performance. These symptoms indicate a systemic reaction of the body and require medical attention.
5. Temperature 37–37.5 ℃ (98.6-99.5 ℉)
Low-grade fever 37–37.5 ℃ (98.6-99.5 ℉) often accompanies an inflammatory process or the body’s reaction to obstruction. If the temperature rises above low-grade values, the risk of infection and complications increases, which requires urgent medical evaluation. Blood pressure may also rise slightly.
6. Nausea and vomiting
Severe pain may provoke autonomic reactions — nausea and vomiting — which further worsen the patient’s condition and may require correction of dehydration and non-surgical pain management.
7. Urine with blood, sediment, and unusual foul odor
The appearance of pink or red urine indicates damage to the ureter wall or renal pelvis by a stone (hematuria); sediment and unpleasant odor usually point to an accompanying infection or a large number of crystals, and require immediate laboratory urine testing.
So, Renal Colic. First Aid
Renal colic is one of those conditions when it is important to act quickly but calmly. Panic, sudden movements, and uncontrolled medication intake only make the situation worse. The goal of first aid is to relieve pain and avoid harm before the doctor arrives.
1. Call a Doctor (Emergency Service) Immediately
During an attack of renal colic, you must call an ambulance immediately! However, it often takes time before the team arrives. This is not the doctors’ fault: traffic jams, weather conditions, and overloaded schedules can delay the response. Therefore, the patient and their relatives must recognize the danger and know what can and cannot be done during acute pain.
2. Ensure Rest and a Comfortable Position
The pain in renal colic is so severe that a person instinctively moves around, seeking a position that brings relief. It is best to lay the patient on their back or on the healthy side and ensure complete rest. Sometimes, the position with knees drawn up to the abdomen helps. All movements should be slow and gentle to avoid worsening the spasm or shifting the stone further.
3. Maintain Warmth (if There Is No Fever or Inflammation Suspected)
If the patient has a history of urolithiasis and this is not the first episode of renal colic, in the absence of fever, a hot bath may help – always in a sitting position. The water should be as hot as the patient can tolerate. However, hot baths are contraindicated for elderly patients or those with cardiovascular diseases or a history of stroke or heart attack. In such cases, first aid should be provided with a hot heating pad placed on the lower back or mustard plasters applied over the kidney area.
Heat dilates blood vessels, improves urine outflow, and lowers pressure inside the kidney. However, it should only be used when you are certain there is no fever, blood in the urine, or signs of infection. Otherwise, heating may accelerate infection and worsen the condition.
4. Pain Relief: What You Can and Cannot Use
If the pain is tolerable until the doctor arrives, it is better to avoid painkillers to make diagnosis easier. The patient may take 2–3 tablets of No-spa (Drotaverine), one Ketanov tablet, or other antispasmodics (Papaverine – 1 tablet). If possible, intramuscular injection (Ketorol, Baralgin) is preferable – it is several times more effective and acts faster. In the absence of these drugs, Nitroglycerin (half a tablet under the tongue) may be used; it relaxes smooth muscles and relieves ureteral spasm.
Nonsteroidal anti-inflammatory drugs, particularly Diclofenac, effectively relieve pain. The optimal option is an intramuscular injection of 75 mg or a rectal suppository of 100 mg. Before the doctor arrives, record all medications taken and monitor urine for stone fragments (it is best to collect urine in a container). If the attack subsides, the ambulance should still not be canceled, as the pain may return if the stone moves further.
Using painkillers during renal colic is not always necessary or beneficial. The symptoms of urolithiasis may resemble those of other abdominal or retroperitoneal diseases. Moreover, the presence of urolithiasis does not exclude the possibility of another acute condition (for example, appendicitis). Therefore, if the attack is atypical, it is better to wait for the doctor and avoid taking any medication.
5. Do Not Try to “Force Out” the Stone
Attempts to “push out” the stone are a common and dangerous mistake. Sudden movements, jumping, excessive water intake, or folk remedies may cause the stone to get stuck, damage the ureter, and worsen the pain. If the stone passes naturally – that is fortunate, but forcing the process is strictly forbidden. The main goal is to wait for medical help and avoid worsening the obstruction.
6. Monitor the Patient’s Condition Until the Doctor Arrives
Heat and antispasmodics can aggravate infection or inflammation in cases of acute appendicitis or other conditions that mimic “acute abdomen.” That is why it is better to wait for the ambulance doctor, who must first exclude such conditions as acute appendicitis, ectopic pregnancy, gallstone disease, peptic ulcer, and others – sometimes in consultation with other specialists.
To help the doctor determine the cause more quickly, it is important to remember and, if possible, note the main details: when the pain began, where it is located, where it radiates, and whether there was fever, nausea, or blood in the urine. If urine was collected after the attack – the first portion should be saved, as it may contain sand or small stones that will help the doctor identify their type. The more accurate the information, the faster the diagnosis and proper treatment can be made.
7. Special Cases: Pregnant Women and Complications
Special attention should be given if the patient with renal colic is pregnant. Treatment of renal colic in pregnancy must take place in a hospital setting. Renal colic in pregnant women is very similar in symptoms to labor contractions, so it is vital to call medical specialists immediately. Be sure to inform the dispatcher that the patient is pregnant and specify the gestational age – this ensures the ambulance arrives faster due to potential risk to the mother and baby.
If you have an ovarian cyst, inform the ambulance team immediately.
When Hospitalization Is Necessary
So, the emergency doctor has examined you and made a preliminary diagnosis of renal colic. What should you do next?
If the medications administered by the ambulance doctor did not bring relief, insist on hospitalization in the on-duty urology department! It is not guaranteed that the diagnosis is correct – anyone can make a mistake, and ambulance doctors do not have portable ultrasound or laboratory testing. Usually, urological hospitals are part of large medical centers with surgical and gynecological departments. There, you can receive more thorough examination with the help of related specialists and get specialized care.
Renal Colic. Diagnostics
Visiting a urologist after an attack
If it was possible to relieve the pain, do not relax, the problem is not yet solved! Wait until morning. Wake up (if you managed to nap), wash up, shave, and head straight to the urologist! I recommend visiting medical centers that also provide urolithiasis treatment, where all necessary conditions for comprehensive examination and care are available.
How to choose a medical center and a doctor
What should you pay attention to first in the resume of the urologist you are visiting (this information can usually be found on the clinic’s website):
- Whether they are proficient in modern diagnostic methods for urolithiasis (ultrasound, X-ray)
- Clinical experience in minimally invasive and endoscopic treatment of urolithiasis
- Clinic equipment – availability of devices meeting modern European quality standards for treating urolithiasis patients (extracorporeal lithotripter, contact lithotripter, laparoscopic tower)
In such a center, the urologist will quickly determine the cause of the colic, assess the risk level, and propose a plan for further examination and treatment.
Why it is important not to delay treatment
It is important to understand that renal colic is only a symptom and most often a sign of urinary tract obstruction. Obstruction of the upper urinary tract is extremely dangerous, and it is crucial to remove its cause as quickly as possible with proper treatment. Otherwise, the patient’s condition will progressively worsen due to secondary infection, increased systemic intoxication, not to mention constant and unbearable pain. In some cases, treatment begins precisely with deblocking the upper urinary tract. Why do I emphasize the timing of treatment? In the first hours after the onset of renal colic, an infectious-inflammatory process has not yet developed in the kidney — the situation is still “uncomplicated.”
Urologist actions during the visit
How does a typical outpatient urologist proceed? Using additional diagnostic methods, they determine the size of the stone, its level of localization, the degree of urinary tract obstruction, and assess changes in urine and blood parameters. Based on this data, expulsive therapy or other treatment methods appropriate to the clinical situation are prescribed.
Renal Colic. Treatment
Modern minimally invasive and low-trauma methods of urolithiasis treatment have fundamentally changed the mentality of a whole generation of urologists, whose distinctive principle today is that regardless of the size, location, or “behavior” of a stone, the patient must and can be relieved of it! This is correct, because even small, asymptomatic stones in the calyces should be eliminated, as there is always a risk of growth and development of chronic pyelonephritis.
Conservative treatment
It is generally accepted among urologists that stones up to 7 mm in size are capable of passing spontaneously (Glybochko P.V., 2012). Therefore, a standard expulsive therapy regimen is prescribed, and everyone waits for the patient to “pass” this annoying stone. In the meantime, repeated renal colic attacks can occur, accompanied by the symptoms described above. Which urologist can accurately tell a patient exactly when the stone will pass?
After all, the diameter of the ureter at its narrowest part (intramural section) is 2–3 mm, while we want a 5–7 mm stone to pass. Yes, in most cases, such stones pass spontaneously. But the question is — how can the patient know whether they will be among the lucky “majority,” how long they must wait, and suffer in the meantime?! According to foreign authors (Preminger GM., 2007; Miller OF., 1999), the probability of spontaneous passage of ureteral stones smaller than 5 mm is 68%, and larger than 5 mm — 47%. The average time for spontaneous passage of stones less than 2 mm is 31 days, 2–4 mm — 40 days, and 4–6 mm — 39 days. Consider these numbers!
When expulsive therapy is appropriate
Expulsive therapy is justified if (this is my subjective opinion based on 17 years of clinical experience treating urolithiasis):
- There is a clear tendency for the stone to pass. In the first hours of a renal colic attack, the stone descends into the lower third of the ureter (ideal location: ureteral orifice). Ultrasound shows urine outflow from the corresponding ureteral orifice (even if weakened), and the stone measures no more than 7 mm. The next day, perform ultrasound control and blood and urine tests. If repeated attacks occur, obstruction worsens, or lab indicators deteriorate — perform extracorporeal lithotripsy (ESWL). If the patient feels well, wait up to 7 days. If the stone has not passed — proceed with extracorporeal or contact lithotripsy.
- A ureteral stone up to 7 mm in size, which cannot be fragmented extracorporeally (absence of ultrasound and X-ray visualization). According to excretory urography, the stone should be smooth. Ultrasound control and blood and urine tests are done once every 3 days. If the patient feels well, wait a maximum of 2 weeks. In case of complications, or if the stone has not passed, endoscopic intervention is performed to remove the stone or provide drainage of the upper urinary tract.
Minimally invasive methods – extracorporeal shock wave lithotripsy (ESWL)
One of the most effective and minimally invasive methods for treating urolithiasis is extracorporeal lithotripsy (literal translation from English — extracorporeal shock wave lithotripsy — ESWL). The extracorporeal lithotripter fragments stones in the kidneys and ureter using focused, high-intensity acoustic pulses.
Method essence and principle of action
The stone is fragmented by a shock wave consisting of pulses of ultra-high and ultra-low pressure. This effect can be compared to the ripples created on water when a stone is dropped into it. When the stone touches the water, it creates high pressure, displacing the water in all directions. After the stone is submerged, a negative pressure zone forms behind it. These diverging waves can be compared to the propagation of the shock wave, under which the stone is broken down.
Stages of stone fragmentation
Stone fragmentation occurs in several stages. First, the dense framework of the stone is destroyed, then cracks form, penetrating deeper with each impulse, eventually breaking the stone into small fragments. As a result, their size does not exceed 3 mm, allowing them to exit the urinary system on their own and without obstruction, thus freeing the patient from the urinary tract stone.
Equipment and targeting methods
For localization and focusing, X-ray imaging is used, often enhanced by ultrasound guidance on many lithotripter models. Extracorporeal shock wave lithotripsy is so minimally invasive that it is performed on an outpatient basis (Lopatkin N.A. et al., 1990; Beschliev D.A., Dzeranov N.K., 1992; Trapeznikova M.F. et al., 1992). Today, many authors have proven the advantages of this method not only over open surgery but also over percutaneous nephrolithotripsy (Ramadan Salahaddin, 1992; Stepanov V.L. et al., 1993).
Method effectiveness and dependence on stone size
The size of the stone is crucial for performing extracorporeal fragmentation of stones in the kidneys and ureter. It largely determines the number of sessions required for complete fragmentation. Larger stones reduce the effectiveness of the primary ESWL session.
For example, stones up to 9 mm in size require only one session in 80% of cases. For stones up to 14 mm, the effectiveness of the primary session decreases to 64%. Extracorporeal lithotripsy is most effective for kidney stones up to 15 mm and for ureteral stones up to 10 mm. When performing ESWL on kidney and ureteral stones, stone density must also be considered. The denser the stone, the more difficult it will be to fragment it on the first attempt.
Ureteral stones up to 10 mm should be treated with ESWL (contactless), and the earlier it is done, the better and more effective!!! It will be much easier and less painful for the patient to “pass” the stone fragments and sand after fragmentation.
Clinical experience and practical examples
I have repeatedly observed situations when a patient crawls into the office with a severe pain attack. Within 15 minutes of visual, palpatory, and ultrasound examination, I diagnose a ureteral stone. Another 45 minutes is spent performing a session of ESWL. And after 1 hour, the patient leaves the day hospital completely healthy, rested, pain-free, and stone-free. Total: 2 hours!!!
Endoscopic stone removal
When ESWL proves ineffective (for example, with large or dense stones), endoscopic treatment methods come to the rescue. Endoscopic stone fragmentation allows the physician to reach the ureter or kidney under visual control and perform targeted stone removal.
Method essence
Endoscopic equipment is inserted through the natural urinary pathways. The doctor visualizes the stone and fragments and removes it using special instruments. Additional energy sources may be used if necessary to break down the stone.
Advantages of the endoscopic approach
- Direct access to the stone and precise impact;
- Ability to remove fragments immediately during the procedure;
- Minimal trauma compared to open surgery;
- Quick recovery and low risk of complications.
When endoscopic removal is applied
The endoscopic fragmentation method is indicated for stones that cannot be expelled or fragmented by ESWL. It is also effective in cases of pronounced urinary tract obstruction, where rapid removal of the blockage and restoration of urine flow is essential.
Laser lithotripsy in the urinary system
A modern development of endoscopic technologies is laser lithotripsy. A holmium laser is used as the energy source, which is delivered directly to the stone through the endoscope. This method is highly precise and effective even for dense stones.
Principle of operation
A laser fiber is delivered to the surface of the stone through an endoscope. The energy of the laser causes the stone structure to break down into the smallest fragments, which can then be easily expelled naturally or removed instrumentally.
Advantages of laser lithotripsy
- Fragmentation of stones of any density and location;
- Minimal risk of damage to urinary tract tissues;
- Possibility of complete stone removal in a single procedure;
- Rapid recovery and low likelihood of recurrence.
When to choose laser stone fragmentation
Laser fragmentation is indicated for complex stones (staghorn, multiple, dense) when other methods are ineffective. Using a laser gives the urologist maximum control and allows achieving the best results even in challenging clinical situations.
Lithotripsy at New Life Clinic
Full range of modern methods
At New Life Clinic, all modern methods for treating urolithiasis are performed: extracorporeal shock wave lithotripsy (ESWL), endoscopic, and laser stone fragmentation. This comprehensive approach allows selecting the optimal treatment method for each patient, taking into account the size, density, and location of the stone.
Modern technologies make treatment as gentle as possible while minimizing the risk of complications. As a result, kidney function is preserved, and the patient is freed from the stone without open surgery.
Advanced equipment
For extracorporeal lithotripsy, the Modulith SLK system from Storz Medical (Switzerland) is used — one of the most effective systems employed in leading urological centers in Europe. Endoscopic and laser interventions are performed using high-precision equipment, ensuring both the safety and high effectiveness of the procedure.
Expertise of specialists
All types of lithotripsy are performed by a urologist with 17 years of experience in minimally invasive treatment of urolithiasis, and who holds a PhD in Medicine. A team of experienced anesthesiologists is involved in the process, guaranteeing the safety and comfort of the patient at every stage of treatment.
Outpatient procedures and comfort
Most stone fragmentation procedures are performed on an outpatient basis. The patient spends only a few hours at the clinic and can return to normal life the same day. This approach combines the effectiveness of high-tech treatment with maximum comfort.