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The differential diagnosis of acute onset flank pain include renal colic, papillary necrosis, pyelonephritis and renal infarction from renal artery thrombosis or embolism. Here, we describe a case of acute onset flank pain caused by unilateral renal vein thrombosis (RVT) in a previously healthy

To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT.This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days.Four-hundred-three patients were randomized in the original study and patients were included in this analysis if they did not have surgery for stone removal and had a CT scan and information on pain medication at follow-up (N = 220). Hydronephrosis was detected in 181 (82%) on initial CT. At follow-up CT, 43 (20%) participants had a persistent ureteral stone. Of these patients, 36 (84%) had no pain, 26 (60%) did not have hydronephrosis, and 23 (53%) had neither pain nor hydronephrosis. Resolution of hydronephrosis was associated with stone passage (RR 4.6, 95% CI 1.9, 11.0), while resolution of pain was not (RR 1.1, 95% CI 0.9, 1.4).In patients with urinary stone disease, stone passage is associated with resolution of hydronephrosis but not resolution of pain. In patients with persistent ureteral stones, neither pain nor hydronephrosis are consistently present. These findings have important implications on follow-up imaging of patients with urinary stone disease.

Introduction To evaluate the efficacy and safety of preforming extracorporeal physical vibration lithecbole(EVPL)through greater sciatic foramen(GSF)for distal ureteral calculi(DUC) treatment. Materials and methods All patients with a diagnosis of DUC (6 - 10 mm in diameter) were enrolled in this study from October 2018 to May 2020. Patients were randomly divided into three groups receiving EPVL through GSF (Group A, n = 58), or abdominal (Group B, n = 60), or combined with oral use of tamsulosin at 0.4 mg daily (Group C, n = 63). Results There was no significant difference observed in terms of demographic characteristics or size of stones among the three groups (p >0.05). Compared with the group B and C, patients of the group A displayed a significantly higher score of comfort but with significantly decreased number of renal colic attacks or analgesics required (p < 0.01). The stone-free rate also significantly increased after one and two weeks of treatment (p < 0.01), despite such a significant difference among these groups vanished after four weeks of treatment. Conclusion Extracorporeal physical vibrational lithecbole in the prone position use the greater sciatic foramen as the path is the safe and effective approach to treat the distal ureter calculi.

Purpose Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results A total of 1,036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.

Background Nephrocalcinosis is often asymptomatic but can manifest with renal colic or hematuria. There is no reported association between nephrocalcinosis and renal vascular malformations, which may also be a source of hematuria. We herein present a case of a patient with hematuria related to nephrocalcinosis and renal papillary varicosities. These varicosities were diagnosed and successfully treated with flexible ureteroscopy and laser fulguration. Case presentation A 24-year-old female with a history of epilepsy (on zonisamide), recent uncomplicated pregnancy, and new diagnosis of nephrocalcinosis presented with right flank pain and intermittent gross hematuria. Imaging revealed intermittent right sided hydronephrosis. A cystoscopy identified hematuria from the right ureteral orifice. Diagnostic flexible ureteroscopy revealed numerous intrapapillary renal stones and varicose veins of several renal papillae. A 200 μm holmium laser fiber was used to unroof these stones and fulgurate the varicosities with resolution of her symptoms for several months. She later presented with left-sided symptoms and underwent left ureteroscopy with similar findings and identical successful treatment. Conclusion Unilateral hematuria from discrete vascular lesions of the renal collecting system may be obscured by other benign co-existing conditions, such as nephrocalcinosis and nephrolithiasis. Although a simultaneous presentation is rare, flexible ureteroscopy with laser fulguration offers an ideal diagnostic and therapeutic modality for these concurrent conditions if symptoms arise.

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®, Sante 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.

Background To review the practice patterns for the acceptance of medically complex living kidney donors (MCLKD) among the transplant providers of the international transplant community. Methods We distributed a survey globally, through major international transplantation societies, among nephrologists and transplant surgeons (TS). The survey contained questions regarding potential donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, smoking, or illegal drug use. Results There were 239 respondents from 29 countries, including nephrologists (42%) and TS (58%). Although most respondents would investigate microscopic hematuria, one-third of them indicated they would decline these potential donors without investigation. Interestingly, most respondents accepted heavy smokers, intermittent illegal drug users (with advice to quit), and those with incidentally identified kidney stones, remote history of renal colic or simple renal cysts. We found multiple areas of consensus in practice with some interesting differences between nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, heavy smoking, or illegal drug use.

Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p p Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.

Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.Results. The average surface area of enhanced and non-enhanced models was 3291 mm2 and 2879 mm2, respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction.

Rupture of the pyelocalyceal cavities or fornix is a rare and potential urological emergency. It is most often secondary to obstructive uropathy. It can lead to extravasation of urine at the perirenal or retro-peritoneal level, which can have serious consequences. The clinic reported the case of a 37-year-old patient who presented to the emergency department with hyperalgesic (right) renal colic. Intense right lumbar tenderness was found on clinical examination, renal function was preserved. The radiological examination, CT scan mainly, revealed a significant ureteralhydronephrosis by urinary meatus calculus measuring 3 mm with a density of 271 HU and a perirenal effusion and extravasation of the PDC at a late time. The emergency therapeutic management consisted of a bypass with a double J stent. The evolution was marked by a clinico-biological improvement.

Cólico renal es una de las patologías consultadas por emergencia, afectando a uno de cada once individuos, se estima que al menos el 50% de estos pacientes presentaran un nuevo episodio de dolor en los próximos 5 años y del 80 al 90 % repetirá un episodio en 10 años, es importante conocer el manejo adecuado para casa caso sobre todo en fase de dolor agudo en la sala de emergencia por lo que se presenta un caso clínico resuelto adecuadamente. Objetivo: actualización bibliográfica sobre el manejo del cólico renal en sala de emergencia. Materiales y métodos: se realizó búsqueda bibliográfica en las principales bases de datos disponibles en la actualidad, encontrando 3 revisiones sistemáticas, 2 guías prácticas de instituciones internacionales de urología, múltiples revisiones bibliográficas y reportes de caso, se seleccionó y cito las fuentes bibliográficas más relevantes y actualizadas. Conclusiones y recomendaciones: Los analgésicos no esteroidales son los medicamentos de elección para manejo del dolor agudo del cólico renal, los analgésicos opioides son de segunda línea. Terapia expulsiva ha demostrado ser útil en cálculos mayores de 5mm localizados en uréter distal. Anuria, infección urinaria y/o dolor refractario son criterios de internación y descompresión de urgencia mediante drenaje percutáneo o colocación de catéter ureteral.

Objectives: To evaluate the safety and efficacy of ultrasound (US) and primary ureteroscopy (URS) in the management of symptomatic obstructive ureteric stones during pregnancy. Patients and Methods...

Background Acute renal colic caused by urinary calculi (ARCUC) has a considerable impact on the quality of life. Acupuncture might be a potential treatment option. However, the evidence is limited. We will conduct this trial to evaluate the efficacy and safety of acupuncture as adjunctive treatment to diclofenac for ARCUC. Methods/design A total of 80 eligible patients who are diagnosed with urinary stone renal colic will be randomly allocated to the acupuncture group or the sham acupuncture group. Each patient will receive 1 session of acupuncture or sham acupuncture. The primary outcome will be the response rate of patients achieving a reduction of > 50% on visual analog score (VAS) from baseline to 10 min after treatment. Secondary outcomes will include the VAS, remedial analgesia, re-visit and admission rate, blinding assessment, credibility and expectancy, and adverse event. All patients who receive randomization will be included in the intent-to-treat analysis. Discussion The finding of this trial will provide evidence on the efficacy and safety of acupuncture for the treatment of ARCUC. The results of this study will be published in peer-reviewed journals. Trial registration ClinicalTrials.gov ChiCTR 1900025202. Registered on August 16, 2019.

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p 10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

Background: Kidney calculi are the most common cause of kidney failure. Objectives: This study aimed to investigate the prevalence of renal colic and its risk factors in the patients referred to two emergency departments during a year. Methods: This was a descriptive cross-sectional study conducted in two hospitals in Kerman city, south-east of Iran, for one year from March 2019 to March 2020. All the archives of the two emergency departments were reviewed, and the required information was recorded in a checklist. The data was analyzed in SPSS 20 software. Results: A total of 504 patients were included in the study. The prevalence of renal colic was 0.5%. Most of the patients (58.5%) had an age between 19 and 39 years, and the majority (60.1%) were males and had a body mass index (BMI) above 25. A family history of renal colic was reported in 68.7% of the patients, and 63.9% had either hypertension or diabetes. Most of the patients consumed less than 3 liters of water per day. The highest referrals were seen in autumn (31.5%) and summer (27.4%). Conclusion: Considering the relationship between renal colic and age, sex, BMI, occupation, a family history of the disease, the presence of underlying diseases, the amount and type of drinking water, and the season of referral, it is recommended to control these risk factors to reduce the incidence of the disease.

In emergency department patients with ureteral colic, the prognostic value of hydronephrosis is unclear. Our goal was to determine whether hydronephrosis can differentiate low-risk patients appropriate for trial of spontaneous passage from those with clinically important stones likely to experience passage failure. We used administrative data and structured chart review to evaluate a consecutive cohort of patients with ureteral stones who had a CT at nine Canadian hospitals in two cities. We used CT, the gold standard for stone imaging, to assess hydronephrosis and stone size. We described classification accuracy of hydronephrosis severity for detecting large (≥ 5 mm) stones. In patients attempting spontaneous passage we used hierarchical Bayesian regression to determine the association of hydronephrosis with passage failure, defined by the need for rescue intervention within 60 days. To illustrate prognostic utility, we reported pre-test probability of passage failure among all eligible patients (without hydronephrosis guidance) to post-test probability of passage failure in each hydronephrosis group. Of 3251 patients, 70% male and mean age 51, 38% had a large stone, including 23%, 29%, 53% and 72% with absent, mild, moderate and severe hydronephrosis. Passage failure rates were 15%, 20%, 28% and 43% in the respective hydronephrosis categories, and 23% overall. “Absent or mild” hydronephrosis identified a large subset of patients (64%) with low passage failure rates. Moderate hydronephrosis predicted slightly higher, and severe hydronephrosis substantially higher passage failure risk. Absent and mild hydronephrosis identify low-risk patients unlikely to experience passage failure, who may be appropriate for trial of spontaneous passage without CT imaging. Moderate hydronephrosis is weakly associated with larger stones but not with significantly greater passage failure. Severe hydronephrosis is an important finding that warrants definitive imaging and referral. Differentiating “moderate-severe” from “absent-mild” hydronephrosis provides risk stratification value. More granular hydronephrosis grading is not prognostically helpful.

To observe the efficacy and safety of Mirabegron in patients with distal, ureteral stones ≤ 10 mm. A total of 90 patients with distal ureteral stones ≤ 10 mm were prospectively randomized into two groups. Forty-five cases in the study group and 45 cases as control. The stone-free rates (SFRs) and renal colic episodes between two groups were compared at the 1st, 2nd and 4th week end by imaging examinations. All of 90 patients were randomly assigned to two groups. In patients with ≤ 5 mm stones, the SFRs in the 1st week (63.6% vs. 33.3%, P = 0.040), the 2nd week (86.4% vs. 54.2%, P = 0.018), and the 4th week (90.9% vs. 66.7%, P = 0.046) after treatment were all significantly higher than that in the control group by the stratification analysis of stone size. Even though SFRs were all higher for patients with > 5 mm stones in study group, there was no statistically significant difference (All P > 0.05). In terms of renal colic episodes, the frequency of occurrence of the study group was significantly lower than that of the control group and need less antalgic. The MET with Mirabegron has a significant role in improve SFR for the patients with distal ureteral stones ≤ 5 mm and no effect in > 5 mm stones. Furthermore, Mirabegron reduces the need for antalgic in ≤ 10 mm stones with low incidence of adverse effects.

Spontaneous rupture of renal pelvis (SRRP) is a rare condition resulting in an extravasation of urine into retroperitoneal space. Due to the uncharacteristic symptoms, often mimicking renal colic, its diagnosis may be complicated. Herein, we report a case of a 73-year-old male with a solitary functioning kidney who presented with malaise and right-sided abdominal pain, rapidly followed by anuria. Laboratory tests showed the signs of AKI. Contrast-enhanced CT performed soon after the admission showed nonspecific abnormalities in the right middle abdomen suspected to be either inflammatory infiltration or surgical scarring. Symptomatic treatment was started, and an acute hemodialysis treatment was commenced. After a temporal improvement, the patient’s general condition worsened significantly, with exacerbated pain and massive increase in plasma creatinine. A second contrast-enhanced CT was performed with an addition of urography phase, revealing the extravasation of the contrast media in the location suggesting the rupture of the renal pelvis. The patient was treated successfully by the placement of a double-J ureteral stent into the ureter. Usually, a clear etiology of SRRP can be determined, that is, urinary tract obstruction, but in this case, we could not find a definite cause. It is important to remember that in the presence of a nonspecific abdominal pain and laboratory signs of AKI, a rare cause like SRRP should be taken into consideration. Performing a contrast CT scan with urography phase can save time in establishing a diagnosis and enable immediate urological intervention.

Objective: The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. Methods: This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone

Background Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. Methods One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. Results Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P Conclusion Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.

Background Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care. Objective The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management. Discussion Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required.

In modern medicine, one of the most common situations requiring emergency care is biliary or renal colic as a manifestation of abdominal pain syndrome. In both cases, smooth muscle spasm plays an important role in the pathogenesis of visceral pain syndrome. Taking into account the fact that, regardless of the chosen treatment tactics, at the first stage it is necessary to stop pain, the question arises about the choice of a drug strategy for the relief of these conditions. It used to be thought that the more intense the pain, the more indications for the prescription of narcotic drugs, which were considered reference analgesics. In recent years, the world has become embroiled in an «opioid crisis». This prompted clinicians to consider the use of drugs from other groups, namely, non-steroidal anti-inflammatory drugs and antispasmodics alone or in combination, which turned out to be no less effective and, often, safer in comparison with narcotic analgesics. New opportunities for effective treatment of visceral pain are opened by the drug Neospastil® (PJSC «Pharmaceutical Company «Darnitsa»), which combines the benefits of nonsteroidal anti-inflammatory drugs (ketorolac tromethamine) with antispasmodic effect of cholinolytics, ganglioblockers and phenytoin phenytoin. The drug increases the effectiveness of analgesia, as well as the control of muscle spasm.

Study objective: to study the effect of a herbal preparation containing a standardised BNO 1040 extract* (based on lovage root, rosemary leaves and aerial parts of centaury) on the extracorporeal shockwave lithotripsy (ESWL) results in patients with urolithiasis (UL). Methodology. 150 patients with UL (aged 18–65 years) treated with ESWL method were divided into 2 equal groups. The main group (n = 75) received standard recommendations and herbal preparation (12 months). The control group (n = 75) received standard recommendations only. The following was evaluated: time and degree of elimination of fragments; the presence of pain and leukocyturia; recurrent stone formation. Results. The elimination of fragments was observed up to 14 days in 94.7 % of patients in the main group versus 76 % of patients in the control group. Renal colic was observed in 6.7 % of patients in the main group versus 10.7 % of patients in the control group; cases of leukocyturia were observed within 14 days in 10.7 % versus 22.7 %, respectively. During the year, a recurrent lithiasis was diagnosed in 6.7% of patients in the main group and in 16 % of patients in the control group. Conclusion. The use of BNO 1040 extract in combination with ESWL: contributes to more rapid and safe elimination of fragments of the calculi and reduces the risk of recurrent stone formation.

BACKGROUND/AIM Diagnostic scores (DSs) for confirmation of acute renal colic (ARCO) have rarely been evaluated. PATIENTS AND METHODS A cohort of 1,333 patients with acute abdominal pain (AAP) were studied, including 59 patients with confirmed ARCO. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for the diagnosis of ARCO. Meta-analytical techniques were used to detect the summary sensitivity and specificity estimates for each data set (clinical symptoms, signs and tests, as well as DS formulas). RESULTS In hierarchical summary receiver operating characteristic analysis (HSROC), the values for area under the curve (95% confidence interval) for i) clinical symptoms ii) signs and tests, and iii) DS were 0.650 (0.612-0.688), 0.724 (0.680-0.768) and 0.962 (0.940-0.984), respectively. In HSROC analysis of the area under the curve values, differences were significant between i) and iii) (p

Background To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS). Methods An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3. Results Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group. Discussion The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.

Objectives To review the literature regarding the epidemiology of stone disease and develop a management algorithm based on current evidence and societal guidelines. Methods A structured literature review was performed to determine highest quality of evidence guiding care for pregnant patients with symptomatic nephrolithiasis. PUBMED and EMBASE databases were searched using terms “pregnancy,” “nephrolithiasis,” or “pregnancy” and “renal colic” alone and in combination with “stone”, “kidney stone,” “ultrasound,” “MRI,” “CT,” “percutaneous nephrostomy,” “ureteral stent,” or “ureteroscopy.” All English-language abstracts were reviewed for relevance and full-length articles were reviewed for content. Articles published prior to 1990 were excluded, and priority for inclusion was given to multi-institutional studies and larger institutional studies, reflecting the highest level of current available evidence and most contemporaneous practice patterns. Results Symptomatic nephrolithiasis affects less than 1% of pregnancies but poses unique diagnostic challenges due to the physiologic changes of pregnancy and risks of ionizing radiation exposure to the fetus. Ultrasound remains the imaging modality of choice. Most patients may be managed non-operatively, but drainage with percutaneous nephrostomy or ureteral stent may be performed if warranted. Growing evidence also supports the safety and efficacy of definitive stone treatment. Conclusions Though rare, symptomatic nephrolithiasis poses significant clinical challenges due to the need to minimize risk for both mother and fetus with diagnostic and therapeutic interventions. A multi-disciplinary approach is paramount, as is shared decision making with the patient at each step of care.

Introduction The effect of ketorolac addition for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of ketorolac addition for renal colic. Methods We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ketorolac addition for renal colic. This meta-analysis is performed using the random-effect model. Results Four RCTs are included in the meta-analysis. In patients with renal colic pain, ketorolac addition is associated with significantly lower pain scores at 10–20 min (SMD=-2.50; 95% CI=-4.31 to −0.68; P=0.007) and analgesic rescue (RR=0.68; 95% CI=0.52 to 0.89; P=0.006), but reveals no notable effect on nausea (RR=0.36; 95% CI=0.12 to 1.12; P=0.08), vomiting (RR=0.50; 95% CI=0.13 to 1.95; P=0.31), or dizziness (RR=0.68; 95% CI=0.05 to 0.60; P=0.007). Conclusions Ketorolac addition may improve the analgesic efficacy for renal colic pain.

OBJECTIVES To examine the gender-related differences in the presentation, management and outcomes of patients admitted with acute renal colic at our institution. PATIENTS AND METHODS A retrospective analysis of 231 consecutive patients requiring inpatient admission for acute renal colic between October 2015 and March 2018. For each admission, data on demographics, admission blood results, stone characteristics, management and outcomes were collected. Differences between genders were compared using the chi-squared and Student's t-test. RESULTS Gender distribution was 35% female: 65% male. There was no significant difference in age, American Society of Anesthesiologists Physical Status Classification grade or history of diabetes. Women had a higher admission C-reactive protein level (89.3 vs 32.9 mg/L, P < 0.001) and neutrophil count (10.0 vs 8.8 × 109 /L, P = 0.04) than men. They also had more positive cultures (34.1% vs 6.0%, P < 0.001) and were more likely to require percutaneous nephrostomy insertion (9.8% vs 0.7%, P = 0.005). Women had more intensive therapy unit (ITU) admissions (12.2% vs 0.6%, P < 0.001) and longer lengths of stay (4.4 vs 1.8 days, P < 0.001) than men. There was no mortality in our series. CONCLUSION In the present study, women admitted with acute renal colic were more likely to have an associated infection than men and require rapid decompression. Although there was no difference in mortality, women experienced greater morbidity as evidenced by the higher rate of ITU admissions and longer length of stay. These differences are important to consider when assessing the suitability of conservative management for female patients.

Objectives To evaluate the impact of COVID-19’s lockdown on radiological examinations in emergency services. Methods Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5–8 and then 12–15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. Results Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p p p p p Conclusion Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.

Objectives To determine the best way to intervene for ureteric stones which still require treatment during the COVID‐19 pandemic, with respect to infection control. In this setting, in which resources are constrained, extracorporeal shockwave lithotripsy (SWL) has prima facie advantages over ureteroscopy (URS). It is also necessary to also consider posttreatment resource consumption in regards to complications and repeat procedures. Subjects and methods The ideal ureteric stone treatment during a pandemic such as COVID‐19 would involve minimum resource consumption and a minimum number of patient attendances. We compared all patients initially treated with SWL to those initially treated with URS for acute ureteral colic within the state of Victoria, Australia in 2017. Results A total of 2724 ureteric stones were analyzed, a cumulative “3‐month exposure and burden on the healthcare system” was calculated for each patient by their initial procedure type. The readmission rate for URS was significantly higher than for SWL, 0.92 readmissions/patient for URS versus 0.54 readmissions/patient for SWL (P

To compare efficacy and safety of parecoxib and paracetamol for treatment of acute renal colic due to ureteric stones.A randomized, double blinded, controlled trial included adult patients presented to emergency department with acute renal colic due to ureteric calculi between June 2019 and August 2020. Patients with hypersensitivity to either drug, peptic ulcer, coronary ischemia, peripheral vascular or cerebrovascular disease, hepatic impairment (Child-Pugh score10) or chronic kidney disease stage 4 or 5 were excluded. Eligible patients were randomized to group 1 who received 1g intravenous Paracetamol infusion or group 2 who received 40mg intravenous Parecoxib infusion. Pain analogue score was evaluated before treatment and 30 minutes afterwards. The primary endpoint was the need for rescue analgesia for persistent pain. Safety was evaluated by the incidence of adverse events.The study included 203 patients (102 in group 1 and 101 in group 2). Pretreatment patients' data were comparable for both groups. The mean pain analogue score decrease from 7.6 to 3.8 in paracetamol group (P.001) and from 7.8 to 3.4 in parecoxib group (P.001). Rescue analgesia were needed in 36 patients (35.3%) in paracetamol group and 27 patients (26.7%) in parecoxib group (P = .187). Minor adverse events developed in 2 patients (2%) in paracetamol group and 3 patients (3%) in parecoxib group (P=0.683).Paracetamol and Parecoxib were effective for treatment for patient with acute renal colic. Both treatments showed comparable results in reduction of pain and need for rescue analgesia with minimal adverse events.

We aimed to explore whether a single-day of fasting (SDF) increase emergency room (ER) visits due to renal colic (RC). We elected to concentrate on Yom-Kippur (i.e.: SDF), the holiest day in Judaism. Food and liquid consumption is prohibited during this day for 25 h, and an estimated 50–70% fasting rate is observed. SDF always takes place between mid-September and mid-October during which the temperature in the Middle-East ranges between 19 and 30 °C. ER visits for RC between 01/2012 and 11/2019 were reviewed, and the Gregorian days on which SDF occurred were retrieved. The number of ER visits for RC was compared between SDF and the surrounding days/months as well as to another single-day "standard" holiday (SDSH) that precedes SDF in 10 days and is not associated with fasting. Of 11,717 ER visits for RC, 8775 (74.9%) were males. Male:Female ratio was 3:1. The mean daily number of ER visits for RC during the 3 days following SDF was 6.66 ± 2.49, significantly higher compared with the mean annual daily visits (4.1 ± 2.27, p p = 0.032), and the mean daily visits during September (5.06 ± 2.659, p = 0.005), and October (4.78 ± 2.23, p p = 0.207; p = 0.13, respectively). It was lower compared to SDF, however statistically insignificant (p = 0.285). A single-day fasting may increase ER visits for RC. The mechanism underlying this phenomenon is unknown.

Objective:The aim of this study is to determine the relationship between each of the three dimensions of a ureteric stone and the passage rate and to identify ureteric stones with an oval/elongated shape and determine whether the stone passage rate was most closely related to any of the three stone dimensions.Materials and Methods:A retrospective study of all patients who had a computed tomography scan with renal colic protocol at our hospital between January 1, 2016 and June 30, 2017. The maximum axial diameter, axial width, maximum coronal length and location of all stones were recorded. Patients were followed up for at least six months to ensure that the stones had been expelled or surgically removed.Results:Ninety patients spontaneously passed their ureteric calculus, and 80 patients received surgery in this study. If the patients who received surgery within three days of diagnosis were excluded, the spontaneous stone passage rate was 81.1%. Of the 90 patients with spontaneous stone passage, 38.9%, 15.6% and 6.7% patients had stones with at least a 1.0, 1.5 and 2.0 mm difference between the maximum axial and coronal dimensions, respectively. Within the subset of calculi that passed within 90 days, these elongated calculi required between 3 and 6 less median days to pass than the more rounded calculi, although this was not statistically significant.Conclusion:This study showed that in isolation, the individual dimension of a ureteric calculus did not significantly affect the time required to pass the calculus spontaneously. Elongated-shaped calculi were not common in this study.

Acute kidney injury is a common clinical problem encountered in general internal medicine. The evaluation of acute kidney injury is mainly driven by the patient’s clinical history, physical exam and basic urinary/laboratory investigation. Point of care ultrasound (POCUS) may be a useful tool to help clinicians to narrow and/or prioritize differential diagnosis in patients presenting with acute kidney injury. Here we present a case of a 67-year old male presenting with dysuria, fevers, and flank pain along with elevation in serum creatinine who was admitted for acute kidney injury secondary to complicated urinary tract infection. Subsequent renal POCUS showed bilateral anechoic fluid collection within the renal sinus with dilated calyces suggestive of bilateral hydronephrosis most likely due to a new diagnosis of benign prostatic hyperplasia. This case demonstrates the use of POCUS added valuable diagnostic information and therapeutic management for this patient presenting with acute kidney injury.

Renal stones are a common cause of non-obstetrical abdominal pain in pregnant women. Though the management of renal stones in pregnancy is challenging, it remains unclear how the incidence of kidne...

Objectives To assess the effectiveness of incorporating hygienic-dietary recommendations in laboratory reports in reducing the incidence of renal colic (RC). A study was performed to compare the incidence of RC in two groups of patients who had suffered at least a crystalluria event associated with the risk of urolithiasis. Recommendations were only incorporated in the laboratory reports of one group. Methods A retrospective observational study. The study sample was composed of patients who had at least an episode of crystalluria associated with a higher risk of urolithiasis. The laboratory reports of patients in Group A (n=1,115), treated in 2017, did not include any hygienic-dietary recommendations, whereas patients in Group B (n=1,692), treated in 2018, received hygienic-dietary recommendations through their laboratory reports. χ2 and Mann-Whitney U test were used to assess differences based on sex, age, and type of urinary crystals. Results The incidence of RC was 2.02 times higher in group A (2.24%) than in group B (1.12%). No significant differences were observed in the incidence of RC based on the type of urinary crystal. The incidence of RC was substantially higher in patients who suffered at least an event of crystalluria associated with a higher risk for urolithiasis as compared to the general population during the same period (0.46%, consistently with the incidence rates reported in the literature). Conclusions The incorporation of messages alerting on the risk of urolithiasis and the inclusion of hygienic-dietary recommendations in laboratory reports may be useful for reducing the incidence of RC.

Opioid overdose was a cause of 42,249 deaths in the United States in 2016 (13.3 deaths per 100,000) and contributed to 67.8% of all drug overdose deaths in the USA in 2017.1,2 The rate of drug overdose resulting in death in Kansas in 2016 was 11.8 per 100,000, (333 total drug overdose deaths).2 Emergency departments (EDs) are a key intermediary in opioid prescriptions. In 2010, 31% of ED visits nationally resulted in an opioid prescription.3 The number of opioid prescriptions from an ED varies greatly even for a single medical indication. For example, states varied from 40% to 2.8% of patients being prescribed an opioid medication from the ED for ankle sprains among opioid-naive patients treated from 2011 to 2015.4 In Kansas, 35.7% of ankle sprain patients received an opioid prescription from an ED.4 Guidelines for acute pain, including the Alternatives To Opioids protocol (ALTO)5 and the Center for Disease Control and Prevention’s Chronic Pain Guidelines (CDC-CPG)6 are available to guide opioid medication decisions. The ALTO protocol can be used to guide administration and prescription of analgesics for indications that include headache/migraine, musculoskeletal pain, renal colic, abdominal pain, bone fracture, and joint dislocation. The protocol encourages the use of analgesics such as acetaminophen, ibuprofen, and ketorolac prior to opioid administration.5 The CDC-CPG guides the provider into setting goals for pain control, discussing appropriate risks and benefits with the patients, and setting criteria for minimizing long-term opioid use,6 but defers to the American College of Emergency Physician’s 2012 clinical policy guideline for opioid management of chronic pain in the ED. The ACEP recommends against prescribing opioids for acute exacerbation of chronic pain in the ED [Level C recommendation].7 Adopting opioid prescribing guidelines has drastically reduced opioid prescribing rates in some locations.8 For example, a study performed in both a community and an academic medical center tested the implementation of an opioid prescribing guideline that resulted in a decline of opioid prescriptions from 52.7% to 29.8% of patient visits.8 Even in a hospital with less frequent opioid prescribing practices, adopting guidelines has reduced opioid administration in the ED from 22.5% to 17.7%.9 In 2017, 17 states had adopted opioid prescription guidelines10; however, Kansas is not one of those states. Knowing little of opioid prescribing practices in Wichita, Kansas, the purpose of this study was to identify factors that are associated with opioid administration and prescriptions in EDs in Wichita, Kansas, and to evaluate what methods are used by local prescribers to limit opioid administration and prescription in a locality without an opioid prescribing guideline.

Early surgical intervention is increasingly employed for patients with ureteral colic, but guidelines and current practice are variable. We compared 60-day outcomes for matched patients undergoing early intervention vs. spontaneous passage. This multicentre propensity-matched cohort analysis used administrative data and chart review to study all eligible emergency department (ED) patients with confirmed 2.0–9.9 mm ureteral stones. Those having planned stone intervention within 5 days comprised the intervention cohort. Controls attempting spontaneous passage were matched to intervention patients based on age, sex, stone width, stone location, hydronephrosis, ED site, ambulance arrival and acuity level. The primary outcome was treatment failure, defined as rescue intervention or hospitalization within 60 days, using a time to event analysis. Secondary outcome was ED revisit rate. Among 1154 matched patients, early intervention did not reduce the risk of treatment failure (adjusted hazard ratio 0.94; P = 0.61). By 60 days, 21.8% of patients in both groups experienced the composite primary outcome (difference 0.0%; 95% confidence interval − 4.8 to 4.8%). Intervention patients required more hospitalizations (20.1% vs. 12.8%; difference 7.3%; 95% CI 3.0–11.5%) and ED revisits (36.1% vs. 25.5%; difference 10.6%; 95% CI 5.3–15.9%), but (insignificantly) fewer rescue interventions (18.9% vs. 21.3%; difference − 2.4%; 95% CI − 7.0 to 2.2%). In matched patients with 2.0–9.9 mm ureteral stones, early intervention was associated with similar rates of treatment failure but greater patient morbidity, evidenced by hospitalizations and emergency revisits. Physicians should adopt a selective approach to interventional referral and consider that spontaneous passage probably provides better outcomes for many low-risk patients.

To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1-6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2-5, 6-10, or 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission.

Background: In view of the high recurrence of kidney stones in patients, the search for less aggressive, preventive treatments has become increasingly essential. Renalof® offers a phytotherapy alternative. Due to its diuretic and kidney stone demineralisation properties, it has been widely used in this patient population, disintegrating and eliminating calcium oxalate and struvite kidney stones painlessly in the genitourinary system. Methods: A Phase II, randomised, prospective, observational, single-blind study with two treatment arms was conducted in order to determine the efficacy of this alternative therapy: a total of 155 patients were enrolled, 120 were assigned to a Renalof® treatment group and 35 to the placebo group. All were over 18 years of age, of both genders, diagnosed with kidney stones of under 10 mm in diameter, present along the entire renal-ureteral-vesicular tract, diagnosed by ultrasound and renal CAT scan. Divided into two study arms, 120 were administered a dosage of a single 325 mg capsule of the Renalof® product half an hour before the two main meals for 3 months. The presence of kidney stones in any part of the renal-ureteral tract was assessed at monthly consultations using one of the above-mentioned diagnostic tools. Results: Study results show a high rate of effectiveness with Renalof®, finding up to a 65% expulsion rate (78 patients) in the first 8 weeks of treatment, compared to 11.4% (4 patients) in the placebo control group, P < 0.001. It is likely a longer follow-up period would be necessary in patients with kidney stones of 10 mm in diameter or larger than the period applied in the study. Discussion: We strongly recommend the inclusion of this product in kidney stone disease management protocols, especially for patients with kidney stones under 10 mm in diameter, where high response and effectiveness have been observed. Thus, it should be evaluated to reduce surgical treatment costs, as well as those for possible colic episodes and other associated complications.

Introduction: To investigate risk factors associated with urinary tract infection (UTI), following ureteral stenting, for patients with renal colic during pregnancy. Patients and Methods: Patients ...

Objective: The aim of the study was to retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings (PIFs) in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. Methods: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January to December 2017 on adult patients from the emergency department with the specific request of urgent evaluation for renal colic, searching for PIFs. Results: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported PIFs between the original report and re-evaluation was significant (p < 0.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the 3 shifts in the original report and in re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopathies, and liver nodules. Conclusions: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to underreport PIFs even in the urgent setting because of the possible consequences on the patient’s health and in order to avoid legal issues, while at the same time satisfying the need for timely and efficient reporting.

Background: Medullary sponge kidney (MSK) is a disturbance of renal development characterized by cystic dilation and diffuse precalyceal duct ectasia. The disease affects both genders in equal proportions and is generally diagnosed in adulthood, as a result of recurrent calcium nephrolithiasis and nephrocalcinosis. The most frequently encountered manifestations being renal colic, microscopic or macroscopic hematuria, and fever. The intravenous pyelogram is standard for diagnosis and metabolic workup is required to identify the underlying cause. The main goal of treatment is to prevent recurrence and disease progression. Though considered a benign condition, a nephrectomy may often be required in patients presenting late with irreversible complications and end-stage renal disease. Aim: To highlight and discuss the presentation and management of a rare case of nephrocalcinosis and nephrolithiasis secondary to the medullary sponge kidney. Case presentation: We report herein the case of a 56-year-old male with long-standing hematuria in whom a diagnosis of medullary sponge kidney disease was made and he underwent a left total nephrectomy. The postoperative course was uneventful. Conclusion: Nephrocalcinosis and nephrolithiasis are complications of MSK and can result in irreversible renal damage. A high index of suspicion is necessary for patients presenting with renal colic, recurrent urinary tract infections, or hematuria for prompt diagnosis and management.

Introduction:Concern regarding radiation exposure has led to increased interest in the use of ultrasound for the initial imaging of suspected renal colic in the emergency department. It is ...

Spontaneous renal artery thrombosis is a rare cause of flank pain and can have fatal consequences. We report a case of acute renal artery thrombosis in a 61-year-old man who experienced flank pain and had no medical history. A contrast-enhanced computed tomography scan revealed total thrombotic occlusion of the left renal artery. The patient was taken to interventional radiology, and an urgent catheter-directed thrombolysis of the renal artery was performed. The procedure was successful, with the subsequent arteriogram demonstrating a substantial decrease of the thrombus extent and the recanalization of the left renal artery. This case highlights that emergency renal artery thrombolysis is an effective and safe treatment for acute occlusion of the renal artery.

Introduction We sought quantify racial disparities in use of analgesia amongst patients seen in Emergency Departments for renal colic. Methods We identified all individuals presenting to the Emergency Department with urolithiasis from 2003 to 2015 in the nationally representative Premier Hospital Database. We included patients discharged in ≤1 day and excluded those with chronic pain or renal insufficiency. We assessed the relationship between race/ethnicity and opioid dosage in morphine milligram equivalents (MME), and ketorolac, through multivariable regression models adjusting for patient and hospital characteristics. Results The cohort was 266,210 patients, comprised of White (84%), Black (6%) and Hispanic (10%) individuals. Median opioid dosage was 20 MME and 55.5% received ketorolac. Our adjusted model showed Whites had highest median MME (20 mg) with Blacks (−3.3 mg [95% CI: −4.6 mg to −2.1 mg]) and Hispanics (−6.0 mg [95% CI: −6.9 mg to −5.1 mg]) receiving less. Blacks were less likely to receive ketorolac (OR: 0.72, 95% CI: 0.62–0.84) while there was no difference between Whites and Hispanics. Conclusions Black and Hispanic patients in American Emergency Departments with acute renal colic receive less opioid medication than White patients; Black patients are also less likely to receive ketorolac.

Study objective To study the effect of a herbal preparation containing a standardised BNO 1040 extract* (based on lovage root, rosemary leaves and aerial parts of centaury) on the extracorporeal shockwave lithotripsy (ESWL) results in patients with urolithiasis (UL). Methodology 150 patients with UL (aged 18–65 years) treated with ESWL method were divided into 2 equal groups. The main group (n = 75) received standard recommendations and herbal preparation (12 months). The control group (n = 75) received standard recommendations only. The following was evaluated: time and degree of elimination of fragments; the presence of pain and leukocyturia; recurrent stone formation. Results The elimination of fragments was observed up to 14 days in 94.7% of patients in the main group versus 76% of patients in the control group. Renal colic was observed in 6.7% of patients in the main group versus 10.7% of patients in the control group; cases of leukocyturia were observed within 14 days in 10.7% versus 22.7%, respectively. During the year, a recurrent lithiasis was diagnosed in 6.7% of patients in the main group and in 16% of patients in the control group. Conclusion The use of BNO 1040 extract in combination with ESWL: contributes to more rapid and safe elimination of fragments of the calculi and reduces the risk of recurrent stone formation. Trial registration DRKS ID 00021200. Registered retrospectively in German Clinical Trial Register 27.03.2020. https://www.drks.de/

Objective Choriocarcinoma is a rare malignant disease that is usually associated with a gestational event. Kidney metastasis might be misdiagnosed as renal cell carcinoma or kidney abscess. To the best of our knowledge, only 13 cases of cutaneous metastasis of choriocarcinoma have been reported in the literature so far. We report a case of choriocarcinoma that manifested with multiple metastases to the lung, skin, kidney and brain. Case report: We reported a case of a 37-year-old woman with a history of hydatiform mole, with symptoms of renal colic and abnormal findings on the skin. Chest X-ray revealed visible focal change 80 mm in diameter, located in the left lung area. The CT exposed in both kidneys multiple hypodense foci, 32 mm in size, suggesting multifocal abscesses with disruptions and perforation to paranephric area. Due to the presence of and temporary loss of vision in the right eye head CT was performed revealing metastatic changes in the brain. The diferential diagnosis between renal cancer, lung carcinoma and choriocarcinoma was achieved only after surgical removal skin lesion. This was the first time in our experience with choriocarcinoma. Immunohistochemically, the analysis was positive for beta hCG, cytokeratin AE1/AE, CK 8/18, CD10, EMA, alfa 1-inhibin and negative for protein 63, CD30 and CD117. Serum hCG level was 394590,0 mIU/mL. Conclusion Conclusions: Choriocarcinoma should be taken into consideration when associated symptoms and significantly elevated blood levels of β-hCG were identified.