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Savoie PH, Boissier R, Long JA. [Renal colic: How to calm and optimize the stone expulsion? Which treatment for pregnant women and children?]. Prog Urol 2021; 31:956-966. [PMID: 34814989 DOI: 10.1016/j.purol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aims of this narrative review was to report on the contemporary data of renal colic (RC) in terms of epidemiology and pressure on emergency structures and also to describe the latest therapeutic developments about uncomplicated RC, depending on the pediatric, adult and pregnancy population. MATERIAL AND METHODS A request to the health surveillance network for emergencies and deaths (SurSaUD®, Santé Publique France) revealed original data on the contemporary epidemiology of renal colic. A narrative synthesis of the articles (French, English) available on the Pubmed database was produced in June 2021. RESULTS Renal colic represents 1.1% of the annual total of emergency room visits. The mean age at admission was 45 years and 62% of patients were men. NSAIDs and Paracetamol are the most effective analgesic treatments and should be given priority over opioids. Non-drug analgesic treatments by tactile stimulation probably have a place in the CN management, particularly in case of contraindications. Among the validated treatments, alphablockers allow better expulsion when the stone is located in the pelvic ureter and if its size is between 5 and 10mm in diameter. In pregnant women, the predominant problem is to confirm the diagnostic. If there is a strong suspicion, MRI or a low-dose CT scan is possible. Ureteroscopy is feasible in particular in the first part of pregnancy to avoid iterative ureteral catheter changes. The care for children is now based on that of adults. CONCLUSION The renal colic care pathway in 2021 can benefit from various optimizations in the field of expulsion and analgesic treatments. Good knowledge of the specific situations in pregnant women and children allowing to improve the quality of care.
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Affiliation(s)
- P-H Savoie
- Hôpital d'instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France.
| | - R Boissier
- Aix-Marseille université, service de chirurgie urologique et de transplantation rénale. CHU Conception, AP-HM, 13005 Marseille, France
| | - J-A Long
- Centre Hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche Cedex 9, France
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Bouyou J, Gaujoux S, Marcellin L, Leconte M, Goffinet F, Chapron C, Dousset B. Abdominal emergencies during pregnancy. J Visc Surg 2015; 152:S105-15. [PMID: 26527261 DOI: 10.1016/j.jviscsurg.2015.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.
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Affiliation(s)
- J Bouyou
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France
| | - S Gaujoux
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - L Marcellin
- Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de gynécologie-obstétrique II et médecine de la reproduction, Hôpital Cochin-Port Royal, AP-HP, Paris, France; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - M Leconte
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - F Goffinet
- Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Maternité, Hôpital Cochin-Port Royal, Paris, France; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - C Chapron
- Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de gynécologie-obstétrique II et médecine de la reproduction, Hôpital Cochin-Port Royal, AP-HP, Paris, France
| | - B Dousset
- Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Piccoli GB, Attini R, Parisi S, Vigotti FN, Daidola G, Deagostini MC, Ferraresi M, De Pascale A, Porpiglia F, Veltri A, Todros T. Excessive urinary tract dilatation and proteinuria in pregnancy: a common and overlooked association? BMC Nephrol 2013; 14:52. [PMID: 23446427 PMCID: PMC3600000 DOI: 10.1186/1471-2369-14-52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/07/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Proteinuria and dilatation of the urinary tract are both relatively common in pregnancy, the latter with a spectrum of symptoms, from none to severe pain and infection. Proteinuria is a rare occurrence in acute obstructive nephropathy; it has been reported in pregnancy, where it may pose a challenging differential diagnosis with pre-eclampsia.The aim of the present study is to report on the incidence of proteinuria (≥ 0.3; ≥ 0.5 g/day) in association with symptomatic-severe urinary tract dilatation in pregnancy. METHODS Case series. SETTING Nephrological-Obstetric Unit dedicated to pregnancy and kidney diseases (January 2000-April 2011). SOURCE database prospectively updated since the start of the Unit. Retrospective review of clinical charts identified as relevant on the database, by a nephrologist and an obstetrician. RESULTS From January 2000 to April 2011, 262 pregnancies were referred. Urinary tract dilatation with or without infection was the main cause of referral in 26 cases (predominantly monolateral in 19 cases): 23 singletons, 1 lost to follow-up, 1 twin and 1 triplet. Patients were referred for urinary tract infection (15 cases) and/or renal pain (10 cases); 6 patients were treated by urologic interventions ("JJ" stenting). Among them, 11 singletons and 1 triple pregnancy developed proteinuria ≥ 0.3 g/day (46.1%). Proteinuria was ≥ 0.5 g/day in 6 singletons (23.1%). Proteinuria resolved after delivery in all cases. No patient developed hypertension; in none was an alternative cause of proteinuria evident. No significant demographic difference was observed in patients with renal dilatation who developed proteinuria versus those who did not. An association with the presence of "JJ" stenting was present (5/6 cases with proteinuria ≥ 0.5 g/day), which may reflect both severer obstruction and a role for vescico-ureteral reflux, induced by the stent. CONCLUSIONS Symptomatic urinary tract dilatation may be associated with proteinuria in pregnancy. This association should be kept in mind in the differential diagnosis with other causes of proteinuria in pregnancy, including pre-eclampsia.
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Dash A, Maiti R, Akantappa Bandakkanavar TK, Arora P. Intramuscular Drotaverine and Diclofenac in Acute Renal Colic: A Comparative Study of Analgesic Efficacy and Safety. PAIN MEDICINE 2012; 13:466-71. [DOI: 10.1111/j.1526-4637.2011.01314.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grissa MH, Claessens YE, Bouida W, Boubaker H, Boudhib L, Kerkeni W, Boukef R, Nouira S. Paracetamol vs piroxicam to relieve pain in renal colic. Results of a randomized controlled trial. Am J Emerg Med 2011; 29:203-6. [DOI: 10.1016/j.ajem.2009.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/27/2009] [Accepted: 09/17/2009] [Indexed: 11/17/2022] Open
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Balssa L, Kleinclauss F. [Management of acute renal colic]. Prog Urol 2010; 20:802-5. [PMID: 21055696 DOI: 10.1016/j.purol.2010.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
Affiliation(s)
- L Balssa
- Service d'urologie et transplantation rénale, CHU de Besançon, 2, place Saint-Jacques, 25030 Besançon, France
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