Ureteric Colic

Ureteric colic is a pain associated with the passage of a stone.
It can be very severe and demands prompt treatment.

Colic is the pain associated with a hollow tube. When a stone passes down the ureter this results in ureteric colic. The ureter is the tube that conveys urine from the kidney to the bladder.

The Pain

Ureteric colic starts suddenly with pain in the loin (flank). The pain radiates round to the front of the abdomen and down to the groin. It can also radiate into the testicle in a man and to the labia in a woman. The pain is very severe. The patient is very restless and uncomfortable and will want to pace the room. Typically each episode will last 30 to 60 minutes. It tends to come and go with an hour or two between attacks.

The pain is caused by the stone passing down the ureter or trying to pass down.

The pain is so severe that the patient may have nausea and vomiting. There may be a temperature if there is an associated urinary tract infection.

When the patient experiences marked urgency to pass urine then the stone could be lodged in the very lowest part of the ureter. The last 2 cms of ureter are in the bladder wall. The irritation produced by the stone in the bladder wall causes the urgency.

loins

Examination

Abdominal examination may be unremarkable. There may be no tenderness despite the severe pain. Tenderness will be elicited in the presence of infection. In this case the patient will have a raised temperature.

Differential Diagnosis

Stones may be confused with the following:

Pyelonephritis
Abdominal aortic aneurysm
Appendicitis
Biliary colic (gallstones)
Peritonitis
Diverticulitis
Salpingitis
Torted ovarian cyst
Ectopic pregnancy
Shingles

Shingles

Initial Investigations

Blood Tests

A full blood count measures the white blood cells in the blood. This is raised in infection
Serum calcium can be measured
Urea and creatinine assesses renal function

Urine Tests

Urine dipstix will reveal haematuria (blood in the urine). The vast majority of stones will have microscopic haematuria
MSU (mid stream specimen of urine) will detect infection

Radiology

KUB (Kidney Ureter and Bladder plain xray). 90% of stones are radio-opaque and can be seen on an xray

staghorn calculus
IVU (IntraVenous Urogram) is a series of xrays following the injection of xray contrast dye. It will show stones and any obstruction. It is thought to be about 92% accurate
Spiral CT is a CT scan taken in a helical way. This is the most accurate method of detecting stones
Retrograde ureterography is performed in doubtful cases. Dye is injected up the ureter at cystoscopy. Stones are seen as filling defects in the ureter
Ultrasound is not routinely used to diagnose stones. It is however used to visualise stone during ESWL

Stones

Any recovered stone should be analysed biochemically

Further investigations

A raised serum calcium (hypercalcaemia) needs further investigations. Primary hyperparathyroidism is one cause which can be cured with an operation called a parathyroidectomy. A raised serum uric acid is treated with Allopurinol. This is an enzyme inhibitor which stops the production of uric acid.

24 hour urine collections to measure output of calcium urate or Cystine

Further Management

This depends on the site and size of the stone. Please see Stones in urology disorders.