Medical Treatment for Renal Colic and Stone Expulsion

Urinary tract calculi have plagued humans since the dawn of civilization. The obstruction of the urinary tract by calculi at the narrowest anatomic areas (ureteropelvic junction, near the pelvic brim, ureterovesical junction) leads to impaired drainage, which usually eventually causes the agonizing pain of renal colic. The primary objective of the therapeutic management of urolithiasis is to provide relief of pain during an event of acute renal colic. Current evidence suggests that nonsteroidal anti-inflammatory drugs and opioids are the “traditional” choices, and some specific agents also may be effective. Adverse events of the medication administered for the management of renal colic should be considered before using these agents.An additional aim of the urologist is to overcome the obstruction and to preserve renal function. Medical expulsion therapy for ureteral stones has been suggested as a method of conservative management of ureteral stones. The aim of this medication is to facilitate the passage of ureteral stones, an area that currently seems to be a field for continuous investigation. Current literature suggests the use of calcium-channel blockers and α-blockers for facilitating expulsion of stones, regardless of size. Nevertheless, patients with stones <10 mm could benefit from a reduced requirement for analgesics and accelerated spontaneous passage of ureteral stones.