medigraphic.com
Órgano Oficial de el Colegio Mexicano de Urología

2002, Number 1

<< Back Next >>

Bol Col Mex Urol 2002; 17 (1)

Acute renal colic treatment with intranasal desmopressin and transrectal indomethacin alone or in combination

Ramírez CE, Landa SM

Language: Spanish
References: 30
Page: 19-25
PDF size: 119.66 Kb.


ABSTRACT

Objectives: To determine if the association of intranasal desmopressin in combination with transrectal indomethacin achieved better clinical results in patients with renal colic than either one alone and to evaluate, sex and age population characteristics, associated symptoms and location of the lithiasis.
Material and methods: It was a clinical, prospective, randomized, comparative trial. 45 patients were included and divided in three; group A, were treated with 40 μg intranasal desmopressin; group B, 100 μg transrectal indomethacin and group C the combination of both. A visual analogous scale was used before, and at 5, 10, 20 and 30 minutes after the drug administration. Data were compared according to “t” Student and chi square (c2) tests. Results: Both drugs did not show statistical significance versus the use of single one (P › 0.05). Nevertheless, 11 patients of group C presented complete resolution of pain versus 6 of the group A and 9 of group B. In 5 patients treated with indomethacin without remission of the pain, when applying intranasal desmopressin sent the pain at 60 minutes. There were 23 women and 22 men, in the study, with an age average of 42 years (22-71 years) and the group of age more affected was 40-49 years. In all the presence of lithiasis was confirmed by renal ultrasound plus scout film of abdomen and/or excretory urography. The most common site of lithiasis was the upper third of the ureter in 13 patients (28.8%) and in 12 (26.6%) renal lithiasis. Nausea and vomit were present in 30 patients (66.6%) and hematuria in 11 (24.4%).
Conclusions: Although, the drug association did not achieved statistical significance, the results make think that with greater number of cases this could be demonstrated. The lithiasis in the upper ureteral third were more frequent and nausea and vomit was present in more than half of the cases.


REFERENCES

  1. Goldman. C. Textbook of Medicine, 21 st. Edition. 2000 Saunders Company.

  2. Blendler. Evaluation of the Urologic Patient. Campbell’s 7th. Edition. Saunders 1998; 131-157.

  3. Marshall L. Litiasis Urinaria: Urología General de Smith. 11va Edición. 1997 El Manual Moderno.

  4. Rosen. Emergency Medicine: Concepts and Clinical Practice, 4th ed. Mosby. 1998; 2250.

  5. Urolithiasis. Urol Clin North Am 2000; 27(2).

  6. Smith RC. Helical CT of Urinary Tract Stones. Radiol Clin North Am 1999; 37(5).

  7. Balaji KC. Mecanismo de formación de cálculos. Clin Urol North Am 1997; Vol. 1.

  8. Aguilar PS. ¿Cuáles son las urgencias urológicas más frecuentes? Rev Mex Urol 1999; 59(6): 247-253.

  9. Gulmi FA. Pathophysiology of urinary tract obstruction: Campbell’s Urology, 7th. Ed. Saunders 1998.

  10. Press. Renal Colic: Em Med Clin North Am 1997; 15(2).

  11. Cohen E. Comparison of ketorolaco and diclofenac in the treatment of renal colic. Eur J Clin Pharmacol 1998; 54(6): 455-8.

  12. Luke G. Efficacy of Ketorolac Tromethamine vs Meperidine in the ED treatment of Acute Renal colic. Am J Emerg Med 1999; 17(1).

  13. Wolfson AB. Oral indomethacin for acute renal colic. Am J Emerg Med 1991; 9(1): 16-9.

  14. Ellenhorn’s Medical Toxicology, 2nd Ed. Williams. 1997; 196-206.

  15. Cordell WH. Comparison of intravenous Ketorolac, Meperidine and both (balanced analgesia) for renal colic. Ann Emerg Med 1996; 28(2): 151-8.

  16. Joes JB. The efficacy of sublingual hyoscyamine sulfato and intravenous ketorolac tromethamine in relief of ureteral colic. Am J Emerg Med 1998; 16(6): 557-9.

  17. Kahn SA. Contribution of endothelin to renal vasoconstriction in unilaterall ureteral obstruction: Reversal by verapamilo. J Urol 1995; 153: 411.

  18. Weiss RM. Physiology and pharmacology of the renal pelvis and ureter. Campbell’s Urology. 7th. Ed. 1998; 839-869.

  19. Ellenhorn’s Medical Toxicology, 2nd Ed. Williams. 1997; 714.

  20. Stasior D. Nephrogenic diabetes insipidus responsive to indomethacin plus DDAVP. N Engl J Med 1991; 324: 850-1.

  21. Ellenhorn’s Medical Toxicology, 2nd Ed. Williams. 1997; 11: 196.

  22. Grenabo M. Antidiuretic hormone levels and the effect of indomethacin on ureteral colic. J Urol 1983; 129: 941-943.

  23. Al-Sahlawi KS. Comparative study of the efficacy of lysine acetylsalicylate, indomethacin and pethedine in acute renal colic. Eur J Emerg Med 1996; 3(3): 183-6.

  24. Wolfson AB. Oral indomethacin for acute renal colic. Am J Emerg Med 1991; 9(l): 16-9.

  25. Laerum E. Intramuscular diclofenaco versus intravenous indomethacin in the treatment of acute renal colic. Eur Urol 1996; 30(3): 358-61.

  26. Kimoto Y. Effects of (1-desamino-8-D-arginine) vasopressin and papaverin on rabbit renal pelvis. Eur J Pharmacol 1990; 175: 359-362.

  27. Moro U. Evaluation of the effects of desmopressin in acute ureteral obstruction. Urol Int 1999; 62(1): 8-11.

  28. El-Sherif A. Treatment of renal colic by desmopressin intranasal spray and diclofenac sodium. J Urol 1995; 153: 1395-1398.

  29. Constantinides C. Management of renal colic with intranasal desmopressin spray. Acta Urol Belg 1998; 66(4): 1-3.

  30. Sener F. Desmopressin versus Indomethacin treatment in primary nocturnal enuresis and the role of prostaglandins. Urol 1998; 52(5): 878-81.




2020     |     www.medigraphic.com