Treatment of Renal Colic in Emergency Hebron Government Hospital

Abstract

The aims the present investigation aimed to point out some data concerning renal colic in Palestine, and to
evaluate the practical clinic approach to it. All the renal colic cases treated in three month in the Hebron hospital ED, reviewed to assess the data, diagnostic and treatment patterns, and to compare them with what is reported in the literature. Retrospective study by review of file of emergency department in three month of renal colic or urinary stone. Renal colic were diagnosed in
three month 300 cases (1%) from all vister of ED; 66% of them were recurrent stone formers; the males 61%, female 39%, The
age distribution, showed a higher rate from 25 to 44 years of age, Ultrasonography (US) was the examination in 72% cases, 99% lab test urine analysis. Diclofen were always used (90%), association with Hyoscine butylbromide, narcotic as pethidin (10%). The data of our investigation are in a substantial agreement with the reported literature bout features of renal colic and its treatment. The diagnostic approach is mainly based on US and lab test. CT-scan was not used in ED. Conclusion; the data of our investigation agree substantially with those reported in the literature as far as concerns of renal colic and its treatment. The diagnostic approach is mainly based on US whereas urine examination, most of patient given Diclofen, and Hyoscinebutylbromide and 10% given narcotic. In pale stain treated the renal colic as national guide.

Full text

International Journal of
Clinical Urology
2017; 1(3): 35-38
http://www.sciencepublishinggroup.com/j/ijcu
doi: 10.11648/j.ijcu.20170103.12
Treatment of Renal Colic in Emergency Hebron
Government Hospital
Mohammad Qtait1, Salah Tamiza2
1Emergency Department, BSN, MSN in Hebron Government Hospital, Al Quds University, Health Professional Collage, Hebron, Palestine
2Emergency Department, Emergency Specialist in Hebron Government Hospital, Hebron, Palestine
Email address:
mohamadtaha98@hotmail.com (M. Qtait)
To cite this article:
Mohammad Qtait, Salah Tamiza. Treatment of Renal Colic in Emergency Hebron Government Hospital. International Journal of Clinical
Urology. Vol. 1, No. 3, 2017, pp. 35-38. doi: 10.11648/j.ijcu.20170103.12
Received: May 19, 2017; Accepted: May 31, 2017; Published: July 18, 2017
Abstract: The aims the present investigation aimed to point out some data concerning renal colic in Palestine, and to
evaluate the practical clinic approach to it. All the renal colic cases treated in three month in the Hebron hospital ED, reviewed
to assess the data, diagnostic and treatment patterns, and to compare them with what is reported in the literature. Retrospective
study by review of file of emergency department in three month of renal colic or urinary stone. Renal colic were diagnosed in
three month 300 cases (1%) from all vister of ED; 66% of them were recurrent stone formers; the males 61%, female 39%, The
age distribution, showed a higher rate from 25 to 44 years of age, Ultrasonography (US) was the examination in 72% cases,
99% lab test urine analysis. Diclofen were always used (90%), association with Hyoscine butylbromide, narcotic as pethidin
(10%). The data of our investigation are in a substantial agreement with the reported literature bout features of renal colic and
its treatment. The diagnostic approach is mainly based on US and lab test. CT-scan was not used in ED. Conclusion; the data
of our investigation agree substantially with those reported in the literature as far as concerns of renal colic and its treatment.
The diagnostic approach is mainly based on US whereas urine examination, most of patient given Diclofen, and Hyoscine
butylbromide and 10% given narcotic. In pale stain treated the renal colic as national guide.
Keywords: Renal Colic, Stones, Emergency Department
1. Introduction
Pain is a most reason for coming to emergency
departments (EDs) [12]. Stone in urinary system is a
common disease in emergency department ED with
prevalence between 7 – 21 cases per 10.000 in habitants in
Western countries [1]. "Renal colic is defined as severe
intermittent flank pain that radiates to the groin, lower
abdomen, or genitalia due to the passage of a stone through
the urinary system. The signs characterized by acute flank
pain which sometimes fluctuates an radiates to the groin and
scrotum in males" [15]. The stones form different causes;
genetic, metabolic, socio-economic, cultural and geographic
factors [3]
Hebron is the largest city in the West Bank and have a
population of around 706.000 (PBCS report, 2015). These
people are the target centers of the service offered by the
hospitals operating in Hebron. In Hebron, there are
governmental and non-government hospitals that operates at
high capacity to meet the population demands. Hospitals in
Hebron operate at the limits of their effective capacity or
even they operate over capacity in some of the hospital
departments. Alia Hospital is the most crowded in Palestine,
operating at 124%, average occupancy rate in 2015 [11] The
second hospital in the West bank crowded ED is Hebron
hospital is the large in 2015. 60750 patient seen in ED, More
than 1000 patient complain from renal colic [11]. No papers
have been published treatment of renal colic in Palestine
emergency departments.
Renal colic pain is a described as severe pain the patient
has ever experienced, Consequently, the use of effective pain
killers like; non-steroidal anti-inflammatory drugs
(NSAIDS), and narcotic, or a combination of medications
(anti-inflammatory and spasmolytic agents), play important
roles in the treatment of these patients [8].
The effect of NSAIDs on relieving pain in renal colic is
similar to opiates, the disadvantage of NSAIDs, in the oral or
rectal form, is the delayed onset time compared with
intravenous morphine. Intravenous forms of NSAIDs are

International Journal of Clinical Urology 2017; 1(3): 35-38 36
available and have a rapid onset, the side effects from the
intravenous form of NSAIDs have been reported more
frequently than for other types of drugs, complications of
NSAIDs include; nausea, vomiting, feeling of heat or
pressure in the chest, fatigue and lethargy [3].
NSAIDs have the advantage of decreasing ureteral smooth
muscle tone, thereby In these cases other analgesics should
be used. Diclofenac is a common NSAID used in patients
with renal colic.
Both parenteral opioids and non-steroidal anti-
inflammatory drugs (NSAIDs) are commonly used to provide
relief from renal colic, and both can have adverse effects
Although opioids are effective and provide rapid analgesia
in renal colic, hypotension, nausea, vomiting and dizziness
are not uncommon after narcotic administration. Paracetamol
is analgesics are commonly employed in combination with
spasmolytic drugs for the treatment of renal and ureteral
colic.
The involvement of prostaglandins promoted clinical
experimentation to investigate the effectiveness of non-
steroidal anti-inflammatory drugs (NSAID) in alleviating the
pain of renal and ureteral colic.
Although the efficacy of spasmolytic agents in renal and
ureteral colic has been debated, they are widely used alone or
in combination with narcotic analgesics in many countries
including Saudi Arabia and other Arabian Gulf countries. In
a renal colic study, a single 20-mg intravenous dose of
hyoscine N-butylbromide (Buscopan) demonstrated that this
spasmolytic agent has a low analgesic effect when it is used
as single therapy or with a 2.5-gm dose of dipyrone [9].
Hyoscine Butyl Bromide is anti-muscarinic agents are
effective in the treatment of smooth muscle spasms
(especially gastrointestinal). Ureteral peristaltic activity of
the genitourinary system is controlled by the autonomic
nervous system so the use of anti-muscarinic agents can be
effective. [5]
The present investigation aimed to point out some data
concerning renal colic in Palestine, and to evaluate the
practical clinic approach to it. For this reason all the renal
colic cases treated in three month in the Hebron hospital ED
have been reviewed to assess the data, diagnostic and
treatment patterns, and to compare them with what is
reported in the literature.
2. Purpose of the Study
The purpose of study present investigation aimed to point
out some data concerning renal colic in Palestine, and to
evaluate the practical clinic approach to it.
3. Method
3.1. Study Design
Retrospective study, take the medical records of the ED in
Hebron Hospital, from 1 may to 31 July 2016, were
reviewed. All the records with a final diagnosis of definite
renal colic or urinary tract stone were selected and collected
for the analysis. The records were carefully reviewed and
unconfirmed diagnoses such as, for example: ‘‘suspected
renal colic’’ or ‘‘pain probably due to urinary tract disease’’,
were excluded from the final analysis.
3.2. Study Period
The date and time of visit was recorded together with the
patient’s age and sex, and, if any, previous history of renal
colic or urinary stones. Information concerning the clinical
presentation, namely abdominal or lumbar pain, side of the
pain, association with hematuria or accompanying symptoms
such as nausea, vomiting or fever, were recorded as well. In
The diagnostic procedures used were specified in every
patients, namely US, and urine examination. Similarly, the
given therapy, namely diclofen, antispastic and analgesic
medications, opioids, were recorded. Lastly, the outcome was
reported, that is admission, discharge or lost at follow up.
3.3. Inclusion Criteria
Were at least 18 years of age (and less than 65 years),
Exclusion criteria were: not diagnosis renal stone, renal
failure, diabetes, hypertension, pregnant and breast feeding
women.
3.4. Study Setting
This study was conducted in the West bank in emergency
department Hebron government hospital south of Palestine.
3.5. Ethical Consideration and Accessibility
Permission obtained to access the MOH hospitals report
when approval by the director of hospital services. Not use
the name or taken the name of participant.
3.6. Data Analysis Procedure
After data collection, from file filled in the table and
entered and analyzed using the Statistical Package for Social
Science program (computer software SPSS V. 22) for
descriptive and inferential statistics. Frequencies were used
to present the distribution of study variables.
4. Result
There were a total of 7,623 ED visits recorded from 1 May
to 31 July 2016. Renal colic episodes were diagnosed in 300
cases (1%); 198 (66,6%) had a previous history of renal
calculi and 183 (61%) were men, 39% female.
The age distribution shows a higher rate among young
adults (from 25 to 45 years of age). The seasonal distribution
outlines the maximum risk during summer months,
particularly in July, and the minimum number of cases during
the winter months.
Pain accounted for the chief complaint in all the cases, and
was associated with nausea and vomiting in 39% of cases.
Fever was present in five patients (1%). Gross hematuria was

37 Mohammad Qtait and Salah Tamiza: Treatment of Renal Colic in Emergency Hebron Government Hospital
observed in only 4% of cases, but microscopic hematuria was
present in 92% of the urine performed. Total of 99% had
urine analysis, and CBC, 69% had BUN and creatinine, US
was the sole examination in 72% of cases.
About 12% of the patients did not receive any drugs in the
ED either because they were already treated at home or any
out medical center, or because pain had subsided in the ED.
300 patients (96%) were discharged, 12 patients (4%) were
admitted to the urology ward after an urologic consultation
(mostly for refractory pain, fever or ultrasound evidence of
severe obstruction).
Table 1. Demographics.
Items Percent frequency
Gender
Male 61% 183
Female 39% 117
Age
less than 30 44.4% 133
Between 30-44 43.3% 130
More than 45 12.2% 37
colic
First 33.4%
Recurrent 66.6%
Laterality of stone
Left side 59%
Right side 41%
Table 1. Continue.
Shift Number Percent
Day 96 32%
Evening 132 44%
Night 72 24%
Table 2. Method of diagnosis.
Method of diagnosis Lab test
Radiology US Other
Urine analysis 99 72 2
Table 3. Type of medication use.
Drug use Percent No
Hyoscine butylbromide, 99%
Pethidin, 10%
Diclofen sodium, 90%
Take all 10%
When therapy was given, NSAIDs (diclofen sodium) were
always used (90%) in association with opiate (tramadol)
(9%) and 96% from patient given (hyoscine butylbromide).
10% given pethidin, 10% given all (diclofen sodium,
hyoscine butylbromide, pethidin.
5. Discussion
One of the primary goals of emergency department staff is
the prompt, and remove suffering from pain for patient
coming in ED. The goal have been poor both in provision of
analgesia and delay to analgesia [6]. The results of our
investigation confirm that renal colic pain is a quite frequent
cause for ED visits. Since the Hebron Hospital inhabitants
area, an annual incidence of 1% inhabitants may be
estimated. Therefore, the epidemiological features we
observed in our region are very similar to that reported in the
literature [3].
Diagnosed in 300 cases (1%) from total this rate of renal
colic or stone (1%) is the same that was reported in world
study involving more than 100 million emergency
department patient presentations [2].
Even if in many cases the clinical presentation was
sufficient to diagnose a renal colic episode, US was
performed in 72% of our patients due to less cost for hospital
and no side effect on patient. Instead, a KUB was not
performed and not request ED of them. This is not in keeping
with Italian guidelines that suggest US as the initial
diagnostic steps because the combination increases the
sensitivity and specificity for urinary tract stone diagnosis
[4]. On the other hand, US is a quick, simple, accurate and
low cost procedure.
90% from patient given NSAIDs, 99% from patient use
Hyoscine butylbromide, less cost and effect and not effect in
balance as narcotic and that accept with study to Regarding
treatment for renal colic, our data are in keeping with the
recommendations of the literature. Several studies show that
NSAIDs administration is the first choice of analgesia for
acute renal colic, and they are at least as effective as
narcotics [5]
The urinalysis is use for every patient complain from
abdominal pain and its available in an emergency setting and
doctors request its not cost and see the microscopic
hematuria before US because of the need to have filled
bladder for this examination.
This study does not seen report use of calcium channel
blockers or a-antagonists, and rom study the physician use
the same protocol in the treatment of renal colic.
The most of patients were able to be discharged.
Admission was only required for complicated cases (fever,
single kidney obstruction) or for those patients who could not
achieve pain relief.
In conclusion, the data of our investigation are in a
substantial agreement with those reported in the literature as
far as concerns of renal colic and its treatment. The
diagnostic approach in Hebron hospitals is mainly based on
US whereas urine examination, most of patient given
NSAIDs, and Hyoscine butylbromide and 10% given
narcotic. In pale stain treated the renal colic as national
guide. The most use diagnosis laboratory test urine analysis
then US in ED.
6. Conclusion
Renal colic were diagnosed in three month 300 cases (1%)
from all vister of ED; 66% of them were recurrent stone
formers; the males 61%, female 39%, The age distribution,
showed a higher rate from 25 to 44 years of age,
Ultrasonography (US) was the examination in 72% cases,
99% lab test urine analysis. Diclofen were always used

International Journal of Clinical Urology 2017; 1(3): 35-38 38
(90%), association with Hyoscine butylbromide, narcotic as
pethidin (10%). The data of our investigation are in a
substantial agreement with the reported literature bout
features of renal colic and its treatment. The diagnostic
approach is mainly based on US and lab test. CT-scan was
not used in ED. The data of our investigation are in a
substantial agreement with those reported in the literature as
far as concerns of renal colic and its treatment. The
diagnostic approach is mainly based on US whereas urine
examination, most of patient given Diclofen, and Hyoscine
butylbromide and 10% given narcotic. In pale stain treated
the renal colic as national guide.
Abbreviation
MOH Ministry of health
PBCS Palestinian Central Bureau of Statistics
ANOVA Analysis of Variances.
ED emergency department
NSAIDS non-steroidal anti-inflammatory drugs
US Ultra sound
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