Renal Colic Research Articles

A case report of ultrasound-guided erector spinae plane nerve block for pediatric renal colic in an emergency department

A case report of ultrasound-guided erector spinae plane nerve block for pediatric renal colic in an emergency department

Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes.

Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina. We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes. Systematic review of the current literature using PRISMA 2020 recommendations. We queried the literature and systematically selected relevant studies according to PRISMA guidelines. Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures. In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.

Efficacy of an erector spinae plane block for renal colic: a systematic review and meta-analysis

Background and aimThe passage of kidney stones through the ureter creates renal colic, a severe visceral abdominal pain. Renal colic is typically managed with non-steroidal anti-inflammatory drugs and opioids. Yet,...

The Effect of Magnesium Sulfate plus Ketorolac versus Morphine plus Ketorolac on Pain Relief in Patients with Renal Colic: A Double-blind Randomized Clinical Trial

Abstract Background: It seems that magnesium sulfate (MgSO4) can be useful in reducing acute pain caused by stone passing through the ureter by reducing ureteral smooth muscle contractions. Aim: This study aimed to evaluate the effect of MgSO4 plus ketorolac versus morphine plus ketorolac on pain relief in renal colic. Methods: The present double-blind randomized clinical trial was performed on 70 patients with renal colic divided into two groups. Patients in the first group received 30 mg intravenous ketorolac plus 5 mg intravenous morphine while patients in the second group received 30 mg/kg MgSO4 plus 30 mg intravenous ketorolac. Then, patients’ hemodynamic parameters and pain scores were evaluated before and 20, 40, and 60 min after the intervention. Results: Within 60 min of administration, systolic blood pressure was significantly reduced in the morphine plus ketorolac group (P &lt; 0.001) while there was no significant change in the MgSO4 plus ketorolac group in this regard (P = 0.576). In addition, the patients’ mean pain scores were not significantly different between the two groups in any of the studied times (P &gt; 0.05). Conclusion: Given that the addition of MgSO4 to ketorolac, as compared with the addition of morphine (as a drug) to ketorolac, has been associated with fewer complications and greater stability of hemodynamic parameters, it can be stated that the use of MgSO4 as an adjunct can be a good choice for further pain relief in patients with contraindications for drug administrations.

A spontaneous rupture of hepatic parenchyma, from imaging to arteriography

BACKGROUND AND AIM: Rupture of the liver parenchyma is an infrequent but potentially serious injury that can occur following different causes. This case report describes the diagnostic and therapeutic procedure in case of spontaneous rupture of the hepatic parenchyma. METHODS: After accessing the emergency room for diffuse abdominal pain, an old female patient arrives in the radiology department and performs a CT scan. RESULTS: The results of the initial CT scan do not point to a full-blown parenchymal rupture; in fact, it is challenging to make a diagnosis because the clinic is so ambiguous and only suggests that the abdomen discomfort may be caused by renal or biliary colic. At the level of the liver parenchyma, only a few hypodense oval forms with specific supra-fluid densitometry have been discovered. CONCLUSION: However, after a few days, the discomfort lingered, and as the condition worsened, the patient underwent additional radiological exams, which revealed a case that required arteriography and a lengthy hospital stay until the resolution.

Clinical Significance of Perinephric Fluid Collection in Patients with Renal Colic and Urolithiasis: A Retrospective Analysis

Background: Perinephric fluid is commonly identified in patients with renal colic and urolithiasis, especially in cases associated with hydronephrosis. However, its clinical relevance, particularly its impact on treatment decisions and prognosis, is not well established. Methods: This retrospective, single-center study included adult patients who presented to the emergency department (ED) with suspected renal colic between January 2021 and October 2023. Patients underwent ultrasound evaluations, which were analyzed for perinephric fluid, hydronephrosis, stone size, and stone location. Data on patient demographics, laboratory results, and clinical outcomes, including the need for urological interventions, were also collected and analyzed. Multivariate logistic regression was used to assess factors associated with perinephric fluid presence. Results: Of the 509 patients included, 200 (39.3%) had perinephric fluid. Hydronephrosis was significantly associated with perinephric fluid (OR: 4.14, p = 0.007), as were stones located in the proximal (OR: 3.06, p = 0.003) and distal ureter (OR: 2.31, p = 0.018). However, sonographic perinephric fluid did not significantly affect the likelihood of urological intervention, in-hospital complications, sepsis, acute kidney injury (AKI), acute kidney disease (AKD), and prolonged hospital stay. Conclusions: Perinephric fluid is a common finding in patients with renal colic and urolithiasis, particularly in cases involving hydronephrosis and ureteral stones. However, despite its prevalence, sonographic perinephric fluid was not significantly associated with the need for urological intervention, longer hospital stays, or worse clinical outcomes. Further prospective studies are required to clarify its clinical implications fully.

Diagnosis and evaluating the urgent CT KUB at king Fahad specialist hospital, Buraydah, Saudi Arabia 2022.

PURPOSE: The aim of this research was to evaluate the diagnostic yield of urgent CT KUBs and assess the appropriateness of their use in the investigation of acute renal colic at King Fahad specialist hospital , Buraydah, Saudi Arabia 2022. METHODS: All data were collected retrospectively from patient’s records including all patients who presented to the emergency and inpatients undergo unenhanced CT KUB to rule out urinary tract stones . Follow-up requests of known urolithiasis and any scan done for other clinical indications were excluded ,representing 3.7% . RESULTS: This study reviewed 1671 patients, 24.9% were aged between 31 and 40 years old, with nearly 60% being males. Most patients were admitted to ER (98%) and referred by non-urology physicians (99%). The prevalence of patients who were diagnosed with renal stones was 38.7%. Among patients who were presented with acute renal colic and CT scan revealed no urolithiasis, there was 11% with incidental and other alternative diagnosis. The most common finding was genitourinary diseases (48.9%), followed by gastrointestinal diseases (27.2%). CONCLUSION: The significant percentage of negative CT KUB of the examined patients reflects the physicians misapplication with this technique with a subsequent reduction in the rate of renal calculi detection with unnecessary radiation exposure as well as increased the alternative/incidental of extraordinary findings, which may indicate further emergency abdominal CT studies. Therefore, urology opinion before CT-KUB requested for patients with atypical presentation is highly advised. Additionally , departmental ultrasound is suggested mainly for the young females prior to CT scan to rule out any gynecological conditions that can mimic renal stones.

Does type of anesthesia during procedural management of suspected renal colic during pregnancy have an impact on preterm birth?

Anesthesia choice during the procedural management of suspected renal colic during pregnancy may vary based on available resources and patient or provider preferences, as there are no specific recommendations. Our objective was to evaluate whether preterm birth (<37 weeks) was associated with anesthesia type, anesthesia timing by trimester, or procedure type. We retrospectively identified pregnant patients who required procedural management with ureteral stent, percutaneous nephrostomy (PCN), or ureteroscopy (URS) for suspected renal colic based on laboratory and imaging findings from 2009-2021 at our center. Analyzed data included anesthesia type (local analgesia only, monitored anesthesia care [MAC], spinal anesthesia, or general anesthesia), trimester of procedure, procedure type, and obstetric outcomes including preterm birth. The study cohort included 96 patients who underwent 231 total procedures, including primary URS, PCN, stent, as well as PCN and stent change. The median gestational age was 38.7 (37.1-39.5) weeks, and preterm birth rate was 15.8%. The most common anesthetic used across all procedures and trimesters was MAC. PCN was associated with the use of less invasive analgesia or anesthesia, whereas endoscopic procedures were more commonly performed with spinal or general anesthesia. Using multivariable logistic regression, procedure type was associated with preterm birth, but not anesthesia type or timing by trimester. Anesthesia type and timing were not associated with preterm birth, and selection may be influenced by resources, clinical scenario, or patient and provider preferences.

Is double-J stent mandatory in complete supine percutaneous nephrolithotomy for adult patients with staghorn renal stones?

It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Effect of Trailokya Vijya Vati in Various Disease – A Review

Introduction: One of the strongest traditional medicines is Trailokya Vijaya Vati, which contains vijaya as one of its main constituents. “Trailokya Vijaya Vati” means “victory over the outer three worlds” in literal translation. According to Ayurveda, the medication is considered a “Aashukari” or drug that offers immediate comfort since it directly affects motor neurons, or “Vaat-Vaahini Naadi.” Because of this, it offers prompt relief from conditions involving different kinds of pain. Materials and Methods: Information on trailokya vijya vati in various disease was gathered from the Laghutrayi, the Brihattrayi and its commentaries, and other Ayurvedic and modern texts. Results: The binary preparation known as Trailokya Vijaya Vati, which combines Vijaya sativa with Bambusa arundianaceae, was initially documented in Rasa Vigyana, a modern Ayurvedic Alchemy and Pharmaceutics treatise. Discussion: Apasmara (seizure disorders), Rajahkashtajanya Shoola (dysmenorrhea and related symptoms), Rajayakshma (tuberculosis and similar wasting diseases), Atisara (diarrhea, colitis, IBS, IBDs, etc.), and Shoola (acute and chronic pains emerging from varied pathologies and origins) are just a few of the plethora of health conditions for which this potent formulation is renowned for producing amazing therapeutic effects. Conclusion: Trailokya Vijaya Vati improves general health and well-being by balancing the three doshas (Pitta, Kapha, and Vata) in the body The main constituents in Trailokya Vijaya Vati, a traditional medicine, are Bambusa arundinacea and Vijaya. The Ayurvedic text Rasa Vigyana describes this powerful formulation, which has been shown to have therapeutic effects for a variety of health conditions, such as anxiety, insomnia, seizures, psychological and psychosomatic disorders, dysmenorrhea, diarrhea, tuberculosis, and acute and chronic pain. The medication helps to manage seizures and has a relaxing impact on the brain.[1] Trailokya Vijaya Vati is also effective in relieving neuropathic pain. One kind of persistent pain that results from harm to the nerve system is called neuropathic pain. Trailokya Vijaya Vati’s natural components have the potential to lessen inflammation and ease neuropathic pain. Chemotherapy adverse effects can be effectively mitigated using Trailokya Vijaya Vati. Abdominal pain and renal colic

Surgical management of obstructing ureteral stones during pregnancy: A systematic review of different techniques.

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Neonatal outcomes after intervention for suspected renal colic in pregnancy

ObjectiveTo compare neonatal outcomes following URS, stent, or PCN in pregnant women presenting with suspected renal colic. MethodsWomen undergoing a procedure for suspected renal colic during pregnancy at a large multi-center institution between 2008–2022 were retrospectively reviewed and categorized by initial intervention. Neonatal outcomes were recorded and linked to maternal and obstetric data. Groups were compared by a Kruskal-Wallis, ANOVA, or Fisher’s Exact test, followed by pairwise post-hoc testing as appropriate (α = 0.05). Multivariate analyses were also conducted. Results95 patients were analyzed, of whom 32 were managed with PCN, 47 with stent, and 16 with URS. Maternal baseline characteristics were similar between groups, except for lower gravidity and parity in the stent group. Rates of premature delivery did not differ, but gestational age at delivery was lower in the PCN group versus the stent and URS groups (p = 0.006 and p = 0.025, respectively). Neonatal Intensive Care Unit (NICU) admission rates were higher in the PCN group versus the stent and URS groups (p = 0.006 and 0.036, respectively). Respiratory distress syndrome significantly differed between groups (p = 0.041). Neonatal birth weight, Apgar scores, and other complications did not significantly differ. ConclusionThis study demonstrated higher rates of NICU admissions and lower gestational age at delivery for neonates born to mothers managed with PCN compared to stent and URS. Larger multi-institutional studies are warranted to further explore these associations.

Parathyroid carcinoma and atypical parathyroid tumor: analysis of an Italian database.

Atypical parathyroid tumor (aPT) and parathyroid carcinoma (PC) are extremely rare parathyroid neoplasms, accounting together for <2% of all parathyroid tumors. They often present an overlapping clinical phenotype, sharing clinical, biochemical, and some histological features. They are distinguished only by the presence of local invasion, and lymph nodes or distant metastasis, which are all absent in aPTs. To date, only few studies have compared clinical presentation and features between aPTs and PCs. Our purpose was to conduct a retrospective study on a multicenter Italian database of aPT and PC patients. We comparatively analyzed main features of aPT (n = 57) and PC (n = 74) patients collected at 15 major endocrinology and endocrine surgery centers in Italy. Atypical parathyroid tumors and PCs showed no significant differences in many clinical features and presented similar values of elevated parathyroid hormone and total serum calcium. Renal complications, namely nephrolithiasis and nephrocalcinosis, appeared to be more common in PC, with a significantly higher rate of renal colic, regardless of total serum calcium levels and 24-h calciuria. Parathyroid carcinomas showed significantly higher postoperative disease persistence and recurrence rates, presumably due to an uncomplete resection of the primary tumor in 23.5% of cases and/or presence of unremoved active metastasis, but they had similar disease-free mean time after surgery than aPT. To deepen the study of malignant parathyroid tumors, the institution of a novel Italian retro-prospective multicenter registry of aPTs and PCs is currently ongoing, and a dedicated PC European registry has been recently activated.

Maternal-Fetal Complications in Renal Colic during Pregnancy: A Scoping Review.

Renal colic is one of the most common non-obstetric causes of hospitalization in pregnant women. Its management is often a challenge for obstetricians/gynecologists, urologists and neonatologists due to the complexity of the problem. The aim of this study was to analyze the possible maternal-fetal complications in renal colic during pregnancy. The authors performed a scoping review of the current literature regarding the analyzed issues. The review was conducted using the PubMed/MEDLINE and Web of Science databases. The search generated a total of 237 articles, out of which 7 original studies were ultimately included in the scoping review. In the women affected by renal colic, the incidence of perinatal complications such as urinary tract infections (UTIs), premature rupture of membranes (pPROM), and preterm birth is markedly higher than reported in the general population of pregnant women. Data regarding the recurrence of other perinatal complications such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PE), and intrauterine growth restriction (IUGR) are scarce and ambiguous. Further research on these issues is needed to improve the perinatal outcomes of the affected pregnancies.

Effects of SLC34A3 or SLC34A1 variants on calcium and phosphorus homeostasis.

Variants in SLC34A1 and SLC34A2 genes, which encode co-transporters NaPi2a and NaPi2c, respectively, can lead to hypophosphatemia due to renal phosphate loss. This condition results in hypercalcitriolemia and hypercalciuria, leading to formation of kidney stones and nephrocalcinosis. Phenotype is highly variable. Management includes hyperhydration, dietary modifications, and/or phosphate supplementation. Thiazides and azoles may be used, but randomized studies are needed to confirm their clinical efficacy. We conducted a retrospective study in the pediatric nephrology unit at Grenoble University Hospital from January 2010 to December 2023. The study aimed to describe clinical and biological symptoms of patients with confirmed SLC34A1 and SLC34A3 gene variants and their outcomes. A total of 11 patients (9 females) from 6 different families had variants in the SLC34A1 (5 patients) and SLC34A3 (6 patients) genes. Median age at diagnosis was 72 [1-108] months. Average follow-up duration was 8.1 ± 4.5years. Presenting symptom was nephrocalcinosis (4 cases), followed by renal colic (3 cases). At diagnosis, 90% of patients had hypercalciuria and 45% had hypercalcitriolemia. Management included hyperhydration and dietary advice. All patients showed favorable outcomes with normal growth and school attendance. One patient with an SLC34A3 variant showed regression of nephrocalcinosis. Kidney function remained normal. Clinical and biological manifestations of SLC34 gene variants are highly variable, even among siblings; therefore, management must be personalized. Hygienic and dietary measures (such as hyperhydration, a low sodium diet, and age-appropriate calcium intake) result in favorable outcomes in most cases. Use of azoles (e.g., fluconazole) appears to be a promising therapeutic option.

EP372 - Initial assessment and management of patients presenting with renal colic

Abstract Aims Abdominal colic secondary to nephrolithiasis is a common presentation to the A &amp; E. Aim of our study is to evaluate the assessment and management of these patients in the first 24 hours of presentation and compare it to standards. Methods Patients admitted to a single surgical unit in a tertiary care hospital with renal or ureteric colic were included in the study. British association of urological surgeon’s guidelines were used as standard. Guidelines were as follows,NSAIDs for analgesia.CT KUB should be performed within 14 hours of admission.Urine dipstick, culture, serum creatinine, electrolyte, calcium, urate, FBC, CRP, clotting screen if per cutaneous intervention is planned. Blood culture if patient is pyrexial or has signs of SIRS. Results Out of 41 patients, 10 (24.3%) were given NSAIDS for pain relief, 16 (39 %) had CT KUB in 14 hours of admission, while 24 (58.5%) had ultrasound abdomen as the first investigation. All patients had FBC, urea, electrolytes, creatinine, urine routine and culture sent. Serum Calcium was sent for only 9 (21.9%) patients. CRP was sent for 8 (19.5%) patients. Out of 4 pyrexial patients, blood culture was sent for 2(50%) patients. Conclusion NSAIDs unless contraindicated, should be used for management of pain instead of antispasmodics. Serum calcium should be sent for all patients with renal colic. Pyrexial patients with urolithiasis should have blood cultures performed. CR KUB plain should be done for all patients of urolithiasis unless a clear contraindication like pregnancy, young age exists. Reference- https://www.baus.org.uk/professionals/baus_business/publications/133/guidelines_for_the_management_of_acute_ureteric_colic/

3D dynamic diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT camera protocol in the evaluation of acute ureteric obstruction caused by ureteric stone

PurposeTo investigate the performance of dynamic 3D diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT for the evaluation of acute ureteric obstruction in patients with urinary stone disease.Methods20 patients who presented to the Emergency Department with acute renal colic due to urinary stone disease confirmed by means of CT were prospectively included. Three observers evaluated and graded hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia from the CT as well as the renal scintigraphy curves from the dynamic SPECT study. The normalized residual activity from dynamic SPECT was analysed at 16 min in all patients and at 20 min in suspected obstruction.ResultsRenal scintigraphy curves showed a sensitivity of 100%, specificity of 93%, PPV 83% and a NPV 100% for obstruction, while normalized residual activity showed a sensitivity of 100%, specificity of 73%, PPV 56% and a NPV 100%. All patients presented at least 2 secondary signs of obstruction on the CT, showing a PPV of only 25% for obstruction.ConclusionDynamic 3D diuretic renal scintigraphy CZT SPECT/CT provides valuable functional and anatomical information from one single examination. The combination of pathological renogram curves and high normalized residual activity values provide the most valuable imaging information to determine the presence of acute ureteric obstruction. The secondary signs of obstruction observed on CT are not specific and should not be used to confirm or discard obstruction in patients with urinary stone disease.Trial registration: ISRCTN15338358. Registration date 03/01/2024. Retrospectively registered. https://www.isrctn.com/ISRCTN15338358?q=miguel%20ochoa%20figueroa&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10

Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust.

Renal colic is a prevalent acute urological emergency caused by urinary stones and commonly manifests as severe loin pain. This audit assesses the management of acute renal colic at a National Health Service (NHS) Trust in the West Midlands, England, comparing practices against theNational Institute for Clinical Excellence (NICE) and the British Association of Urological Surgeons (BAUS) guidelines. This retrospective audit reviewed 417 patients with suspected renal colic over a month. Data collected included patients' demographics, time to complete CT scan, laboratory investigations requested and management modalities. Patients assessed were either admitted through the Emergency Department, Surgical Assessment Unit, or previously admitted for other conditions on the wards. The audit benchmarked against NICE and BAUS guidelines, focusing on diagnostic timeliness and management, including essential blood investigations. Data analysis performed using SPSS (IBM Corp., Armonk, NY, USA) included descriptive statistics and Chi-square tests, with significance set at p < 0.05. A total of 417 patients met the inclusion criteria. The average age of patients was 47.4 years with slightly higher male population (51.1%). The diagnostic rate for renal or ureteric stones using computed tomography of the kidneys, ureters, and bladder (CT-KUB) was 41.2%. The positive detection rate was significantly higher in males (54%) compared to females (27.5%) while females have more alternate diagnosis than males (13.7% vs 6.1%). The average completion time of CT-KUB was nine hours with 7.7% of patients having their CT-KUB beyond the 24-hour benchmark. Most patients (48%) were managed conservatively with analgesia, 32% received tamsulosin as medical expulsive therapy and others had interventions like ureteric stent insertion (9.3%), nephrostomy (6.4%) or primary ureteroscopy (4.1%). The audit of renal colic management at our centre revealed a 41.2% diagnostic rate for renal or ureteric stones via CT-KUB, with a significantly higher rate in males than females. Diagnostic delays were minimal, with only 7.7% of scans exceeding 24 hours. Conservative management was common, however non-steroidal anti-inflammatory drugs (NSAIDs) were underutilized despite guideline recommendations. There was a notable gender disparity in diagnostic and alternate findings rates. The results showed the need for adherence to pain management protocols and highlight the effectiveness of existing renal colic protocol, while also pointing to potential areas for improvement in treatment uniformity and guideline adherence.

Flavonoids from leaves of Duguetia furfuracea

This study investigates the phytochemical profile of the leaves of Duguetia furfuracea, a shrub native to the Brazilian Cerrado and traditionally used in folk medicine for the treatment of dysmenorrhea, diarrhea and rheumathism, stomach pain, renal colic, spine pain and soothing. The leaves were extracted with a mixture of ethanol/ water (8:2), and the extract was then subjected to a series of purification steps using various solvents and chromatography techniques. This process yielded two known flavonoids, kaempferol and isorhamnetin, that were identified through analysis of NMR spectra incomparison with litrature data. The flavonoid kaempferol is being described for the first time in the species D. furfuracea, even though this species already has several phytochemical studies. The isolation of these flavonoids contributes to our understanding of the plant's chemical composition and highlights their potential to contain diverse classes of compounds. This knowledge can be valuable for scientifically validating traditional medicinal uses of D. furfuracea and for developing novel therapeutic agents derived from natural sources.

Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED). A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects. Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others. Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.