Education And Debate


BMJ 1996; 312 doi: (Published 30 March 1996) Cite this as: BMJ 1996;312:838
  1. Chris Dawson,
  2. Hugh Whitfield

    Some urological conditions that are seen in general practice should be considered to be emergencies.

    Conditions that may need urgent treatment

    • Renal colic

    • Acute retention of urine

    • Priapism

    • Testicular torsion

    • Paraphimosis

    Renal colic

    Although some stones remain asymptomatic, most will give rise to pain at some time. However, despite their size, staghorn calculi are often painless because of their inability to move within the renal collecting system.

    Narrow points in upper urinary tract

    • Caliceal neck

    • Pelviureteric junction

    • Pelvic brim

    • Vesicoureteric junction

    The symptoms resulting from renal and ureteric stones can be predicted from a knowledge of the likely site of obstruction. Renal colic usually starts abruptly with flank pain, which then radiates around the abdomen as the stone progresses down the ureter. Typically pain is felt in the testes in male patients and the labia majora in female patients.

    Physical signs of renal colic

    • Severe pain

    • Inability to obtain rest, irrespective of position (unlike patients with peritonitis, who typically lie still and resist moving)

    • Paleness and sweatiness

    • Mild tenderness on deep abdominal palpation

    In male patients the external genitalia and testes must be examined so that testicular torsion can be excluded, and a rectal examination may be necessary to rule out other diagnoses.

    The investigation of a patient with suspected renal colic should begin with routine urine analysis. Some patients have frank haematuria, but the rest have microscopic haematuria. If the results of urine analysis are normal then an alternative diagnosis should be considered.

    Patients suspected of having a stone should have intravenous urography unless they have a history of allergy to contrast media or are pregnant (renal ultrasonography is useful in these circumstances to show caliceal dilatation on the affected side).

    Differential diagnosis of renal colic

    • Acute appendicitis

    • Diverticulitis

    • Salpingitis

    • Ruptured aortic aneurysm

    • Pyelonephritis

    Initial management is directed towards controlling the …

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