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
The main cause of renal colic is mechanical obstruction of the urinary tract, most often due to stones. When a stone blocks urine flow, intrarenal pressure rises sharply, leading to edema, irritation of nerve endings, and severe “stabbing” pain. This condition may occur suddenly and take a person by surprise, resembling a storm inside the body.
Factors that can trigger an attack:
An attack often occurs after intense physical activity, driving on a bumpy road, or excessive intake of fluids or alcohol. Any sudden jolt or overstretching of the urinary tract can “push” the stone and trigger colic. Inflammatory processes also increase the risk, making the ureteral walls more sensitive to pressure.
Other possible causes:
Stones are not always to blame. Renal colic may be caused by kidney or ureteral tumors, cysts, blood clots, or mucus, as well as congenital or acquired anomalies of the urinary tract structure. All these factors disrupt normal urine outflow and create the conditions for a sudden and painful attack.
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.
Renal colic. First aid
The very first aid for renal colic is ensuring complete rest for the patient and providing free space. Patients usually toss about in an attack of pain, unable to find relief, so it is important to create comfortable conditions. If the pain can be tolerated until the doctors arrive, it is better to avoid painkillers, as this makes preliminary diagnosis easier.
Call a doctor (emergency services) immediately
At the onset of a renal colic attack, it is necessary to immediately call emergency services! However, it often takes time before the team arrives. This is not the doctors’ fault: traffic jams, weather conditions, busy schedules, and other factors can delay their arrival. Therefore, the patient and their relatives must be able to recognize the danger and know what can be taken at the peak of pain and what may cause harm.
Providing rest and keeping warm
If the patient is a stone-former, suffering from long-standing urolithiasis, and this is not their first renal colic attack, in the absence of fever, they can be placed in hot water — but strictly in a sitting position. Note that the water should be very hot, as much as the person can tolerate. A hot bath is contraindicated for patients (especially the elderly) with serious cardiovascular diseases, or those who have suffered a stroke or heart attack. For such patients, first aid should be provided with a hot heating pad placed on the lower back, or mustard plasters applied to the kidney area.
Pain relief with medications: what is allowed and what is not
The patient may take 2–3 tablets of No-shpa (Drotaverine), one tablet of Ketanov, or another antispasmodic (Papaverine – 1 tablet). If possible, it is better to administer the drugs intramuscularly (Ketorol, Baralgin) — this increases effectiveness several times and provides faster relief. In the absence of these medications, nitroglycerin (half a tablet under the tongue) can be used, as it also relaxes smooth muscle and may relieve ureteral spasm.
Nonsteroidal anti-inflammatory drugs, particularly Diclofenac, are also effective in relieving pain. The optimal method is intramuscular injection of 75 mg or rectal administration of a 100 mg suppository. Before the doctor arrives, it is important to record all medications taken and monitor urine for the passage of stones (ideally by collecting urine in a container). Even if the attack subsides, you must not cancel the doctor’s visit, since the pain may return (the stone, if it caused the obstruction, can move further, temporarily relieving the spasm).
Using painkillers for renal colic is not always necessary or beneficial. The manifestations of urolithiasis (urolithic disease) may resemble symptoms of other abdominal and retroperitoneal diseases. Moreover, having urolithiasis does not exclude the possibility of another acute condition (for example, appendicitis). Therefore, if the attack is atypical, it is better not to take any action until the doctor arrives.
Monitoring the patient’s condition until the doctor arrives
Heat and antispasmodics may aggravate infectious-inflammatory processes in cases such as acute appendicitis or other conditions with “acute abdomen” symptoms. This is why it is safer to wait for the emergency doctor, who will first rule out conditions such as acute appendicitis, ectopic pregnancy, gallstone disease, peptic ulcer disease, etc., sometimes with the assistance of specialists from other fields.
Special cases: pregnant women and complications
Special attention should be given to a patient with renal colic if she is pregnant. Treatment of pregnant women with renal colic must be carried out only in a hospital setting. Renal colic in pregnant women can closely mimic labor contractions, so it is crucial not to delay and immediately call specialists. Be sure to inform them that the patient is pregnant and state the gestational age, as this accelerates the response due to the potential risk to both mother and child.
If you have an ovarian cyst, you must immediately inform the emergency team.
When hospitalization is necessary
So, the emergency doctor has examined you and made a preliminary diagnosis of renal colic. What happens next?
If the medications administered by the emergency doctor have not brought relief, insist on your hospitalization in the on-call urology department! It is not guaranteed that you have renal colic — mistakes can happen, and the emergency team does not carry a portable ultrasound machine or biochemical lab with them. Urological hospitals are usually part of large medical centers that also include surgical, gynecological, and other departments. In such facilities, you can receive more thorough diagnostics with the involvement of related specialists, as well as specialized treatment.
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.
