What is renal colic?
Renal colic is an episode of intense, spasmodic pain that appears sharply and suddenly, and progressively increases in intensity. The pain starts in the lower back and radiates laterally into the abdomen, groin and genitals. The intensity is not constant, but involves peaks of more intense pain mixed with periods of slight remission. The duration is also variable, from several hours to two or three days, although colics with a duration of only a few minutes are not uncommon. It is usually accompanied by general symptoms, sweating, nausea and/or vomiting and, frequently, fever. It may occasionally cause voiding discomfort such as the need to frequently urinate in small volumes, a sensation of incomplete emptying of the bladder and/or a stinging sensation during urination. The urine is usually dark, concentrated and sometimes the presence of blood is visible to the naked eye.
What are the causes?
There are many causes of renal colic: it can be caused by factors such as insufficient fluid intake or a family history of the condition, among other things. However, the most common cause is the presence of stones in the ureter, which are formed from crystallised mineral salts that are usually excreted in the urine. These stones form when there is a high concentration of these substances in the urine. When stones are present, the obstructed kidney retains urine and dilates the urinary tract, which causes pain. In addition to stones, any other substance that fills the ureter and obstructs the kidney can cause colic.
When managing the onset of renal colic, the priorities are to achieve quick and satisfactory pain control, facilitate the excretion of the stone and avoid the reappearance of the condition. The initial treatments of choice for pain relief are spasmolytic and anti-inflammatory analgesics. During episodes of extreme pain these drugs can be administered intramuscularly or intravenously. To improve efficacy, these treatments are often complemented with drugs that prevent nausea and vomiting.
It is very important to assess the size, location and shape of stones at the time of the initial diagnosis, as well as the probability of spontaneous excretion, their composition, the symptoms, and whether a urinary infection is present.
In a large number of lithiasis cases, stones of 5 mm and below are usually excreted spontaneously. If the stones are larger and it is not possible for them to be excreted, fragmenting them into tiny pieces so that they can be excreted naturally with the urine is also an option (ESWL). If this procedure cannot be performed or the colic is complicated, a surgical removal will be performed.
At the Serrate & Ribal Institute of Urology, we have state-of-the-art equipment and cutting-edge techniques for fragmenting or surgically removing these stones: