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Renal colic: Pain and beyond pain! - Syed Mamun- Mahmud Lifecare Hospital

Syed Mamun

Renal colic emerges as smooth muscle contraction waves from pelvicalyceal system down to UVJ in response to partial or complete obstruction in the urinary tract. It is one of the common reasons for ER visit in UAE. Urinary stones are the most common cause, followed by clot and papillary necrosis. Such pain is frequently incapacitating and not infrequently intractable to traditional oral and injectable analgesics. Primary aim in managing such painful condition is of course relieving pain and at the same time identifying the cause to prevent future episodes. It is interesting to note that urinary stones in general and ureteric in particular may have a wide range of presentations from classic colic to nonspecific abdominal pain, testicular pain, urinary symptoms including retention of urine. Likewise the pain itself has multitude of effects starting from his own self (renal dysfunction, infection, emergencies like retention of urine) to accidents impacting others by the patient being in different professions (driver, pilots, crane 
operators, etc.). In addition, there are other considerations in managing stones like radiation exposure and special associations like pregnancy, systemic disorders (MEN) and solitary kidney. In due consideration to the high and ever increasing prevalence of urinary stone disease, its recurrent nature, the impact on overall health with potential to progress to higher CKD, all international guidelines emphasized a minimally invasive with aggressive renal preservation approach. Looking at the high prevalence urinary stones in the region (UAE), the subject is highly relevant for all health care providers. And it is vital for all physicians from general physicians to specialists and ER physician to identify renal colic beyond pain and be cognizant of various presentations, point of urgent referral and due considerations in managing such patients that includes immediate pain relief, choice of analgesics, renal function, radiation exposure and issues in special situations like pregnancy.