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Abstract |
Urinary track calculi or urinary stones, formed from crystalized chemicals in the urine such as calcium oxalate, uric acid and cystine, occur in one of ten Canadians in their lifetime. The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads to impaired drainage and severe pain (renal colic). The treatment of renal colic includes conservative treatment including rehydration, analgesia, and drugs to enhance stones expulsion, and surgical treatments such as uteroscopy, percutaneous nephrolithotomy and open/laparoscopic lithotomy. Pain therapy includes drugs such as paracetamol, narcotics, corticosteroids, and acupuncture. Drugs that enhance expulsion include cyclooxygenase inhibitors, corticosteroids, alpha-blocker therapy, or calcium-channel blocker therapy. The stone composition, size and location are key determinants for predicting spontaneous stone passage and therefore dictate the type of therapy used. Stones less than 5mm in diameter and located in the distal ureter are more likely to pass spontaneously with facilitation from drugs that enhance expulsion than larger stones and stones that are located in the proximal ureter which need surgical therapy. Small stones can also be treated with extracorporeal shock wave lithotripsy. The economic burden of urinary stone treatment is estimated at US$5 billion including direct and indirect costs in 2005. Because of the great variability in renal colic management, this Rapid Response report aims to review the comparative clinical and cost-effectiveness of different treatment strategies of renal colic. |
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