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Background and Purpose: The management of acute renal colic is a problem commonly encountered by both urologists and emergency medicine physicians. The classic approach to managing uncomplicated acute renal colic involves hydration, along with imaging and pain control. Previous studies have suggested that hydration has a significant impact on patient comfort, as well as spontaneous stone passage. This study evaluated the effects of maintenance v forced hydration and its effect on the pain experienced from renal colic., Patients and Methods: Forty male and 18 female patients with a mean age of 41 years suspected to have acute renal colic were identified in the emergency department. After screening and informed consent, the patients were enrolled in the study, and 43 patients were eventually available for analysis. Patients received intravenous (IV) analgesia, imaging with a noncontrast CT scan of abdomen and pelvis, and assignment to either forced IV hydration with 2 L of normal saline over 2 hours (N = 20) or minimal IV hydration at 20 mL of normal saline per hour (N = 23). A visual analog pain scale was completed hourly for a total of 4 hours. Demographic information, laboratory and imaging results, narcotic use in morphine equivalents (ME), and pain scores were recorded and compared. Spontaneous stone passage rates were also calculated by careful patient follow-up. Results were considered statistically significant at p < 0.05., Results: Stone size was equivalent in the two treatment groups (p > 0.05). There was no difference in the narcotic requirement in ME (p = 0.644) between the two groups. Similarly, there was no difference in hourly pain score or stone-passage rates between the groups (p > 0.05)., Conclusions: Treatment of uncomplicated renal colic has traditionally included vigorous intravenous hydration, as well as medications for the control of pain and nausea. Our data suggest that maintenance intravenous fluids are as efficacious as forced hydration with regard to patient pain perception and narcotic use. Moreover, it appears the state of hydration has little impact on stone passage.

Background and Purpose: The Frequency-Doubled Double-Pulse Nd:Yag) (FREDDY) laser (World of Medicine, Berlin Germany) is a short-pulsed, double-frequency solid-state laser with wavelengths of 532 and 1064 nm. This low-power, low-cost laser was developed for intracorporeal lithotripsy. We designed an experimental set-up to test its fragmentation efficiency at different energy and frequency settings., Materials and Methods: Forty previously weighed plaster-of-Paris stone phantoms were divided into four groups in order to test fragmentation at 5 and 10 Hz for 2 and 4 minutes. A hands-off underwater laboratory set-up including a holder to keep the stone phantom in contact with the quartz laser fiber was utilized. The 280-microm laser fiber was cleaved and stripped between runs to ensure optimal energy delivery. After fragmentation was completed, all of the stone fragments remaining within the holder were allowed to desiccate for 48 hours and reweighed. Fragmentation was measured as the percentage weight loss., Results: Stone phantoms fragmented at 5 Hz for 2 minutes sustained a mean 24% loss of weight, whereas the 4-minute treatment at 5 Hz reduced stone weight by 54%. Treatment at 10 Hz for 2 minutes demonstrated results similar to those of stones treated for 4 minutes at 5 Hz, reducing stone weight by 51%. Fragmentation at 10 Hz for 4 minutes revealed a 64% loss of mass, less than expected for these power settings. Fiber deterioration observed at the higher energy settings may be the cause of the reduced stone-fragmentation efficiency., Conclusions: Fragmentation with the FREDDY laser in the 5 Hz, 4 minutes and 10 Hz, 2 minutes protocols is comparable, suggesting that stone fragmentation correlates well with the total energy delivered to the stone. The slight drop in fragmentation efficiency at 10 Hz, 4 minutes is most likely explained by fiber damage occurring consistently at these higher energy settings. The safety profile and low investment and running costs of this laser are advantages that suggest the laser warrants further clinical trials.