Obstructive uropathy and nephritic colic

Nephritic colic is severe pain that originates at the height of the kidney or urinary tract due to an acute obstruction in these areas caused by lithiasis (stone or kidney stone).

This obstruction causes urine not to advance along the urinary tract; is held back. This produces an increase in pressure within the urinary tract that is the cause of the pain that accompanies nephritic colic.

Nephritic colic is a fairly frequent problem: in Spain four out of every hundred people manifest this disease, which means about one hundred thousand new cases a year.

Aetiology

In addition to stones, any other element that occupies the ureter and obstructs the kidney can cause colic. This is the case of some tumors that grow inside the ureter or encompass it from neighboring organs such as the intestine, ovary, or
uterus
.

It can also be caused by benign diseases such as retroperitoneal fibrosis or vascular dilations such as aortic aneurysm

.

It is important not to confuse it with other conditions that have low back pain as a symptom.

Kidney stones can have four origins:

1. Most stones, between 70 and 80%, contain calcium. They are just as common in men as in women.
2. Between 20 and 30% of stones are caused by
   urinary tract infections
   (by germs called urea splitters). This type is much more common in women than in men. They are larger stones that usually remain in the kidney.
3. Between 5 and 10% of kidney stones are produced by uric acid. They are the only ones that can be disposed of with treatment, alkalizing urine. The people who have
   Gout
   has usually suffered some nephritic colic.
4. 1% of the stones are due to cystinuria, a disease of genetic origin.

Symptoms

The most important symptom is pain in the lower back, which appears abruptly and intensely.

Usually, this pain radiates to the bladder and genitals, following a downward trajectory although the irradiation depends on the level of the obstruction.

The pain is usually accompanied by nausea, vomiting, and sweating.

Other common symptoms that may occur are:

• Fever and/or signs of sepsis. Nephritic colic with fever is a VITAL EMERGENCY that should be assessed immediately in the emergency room. Uros Associats has specialists located to attend the Urological Emergencies of Clínica Sagrada Familia and Teknon Medical Center

• Hematuria: It is the presence of blood in the urine. It may appear in small amounts so it should be detected through urine tests or it may be visible.

• Dysuria: difficulty or pain of the patient in the evacuation of urine.

• Pollakiuria: increase in the number of urinations during the day, which are usually of small amount.

• Anuria: Definitive suspension of urine secretion. This is the sign of greater severity.

The pain may vary in location as the lithiasis progresses in the urinary tract:

• In renal cramps, the pain is located more intensely in the renal fossa, radiating to the hypochondrium (area of the abdomen located under the diaphragm and floating ribs).
  
• In ureteral cramps the pain radiates to the genitals.

Kidney or ureteral stones (the most common cause of colic) produce varying degrees of suffering in the urinary tract, which can be classified depending on the degree of obstruction and the dilation it produces in the system. There are different degrees of dilation, depending on the obstruction:

• Grade I: slightly dilated renal pelvis without calyx dilation.
• Grade II: moderately dilated renal pelvis with mild calyx dilation.
• Grade III: enlarged renal pelvis, dilated calyxes and normal parenchyma.
• Grade IV: enlarged renal pelvis, dilated calyxes and thinning of the renal parenchyma.

Diagnosis

To confirm the disease, the specialist must study if the patient suffers from fever, since this symptom can lead to other clinical pictures that require different approaches.

For clinical diagnosis, the specialist studies the presence, first of all, of the following symptoms :

• Acute onset abdominal pain.
• Irradiation to the groin or genitals.
• The patient does not feel an improvement with rest or changes in posture.

Nausea and vomiting

After this evaluation, the specialist will perform a physical examination that will consist of:

• An abdominal and lumbar scan
  
• A vital signs test.
• In addition, other tests may be performed, such as blood and urine tests, x-rays of the abdomen, ultrasound and abdominal tomography to detect the location of the stones.

Imaging tests are very useful in diagnosis and guide the specialist on how to manage the pathology. The images also reveal the degree of obstruction caused by lithiasis in the urinary tract.

Treatment

Treatment should be done as quickly as possible to avoid complications and control pain.

The specialist usually prescribes non-steroidal anti-inflammatory analgesics which are effective against pain and inflammation. In very acute episodes of pain, this can be treated through the application of drugs intramuscularly or intravenously.

It is also usually necessary, in a large number of cases, to administer medications to reduce or eradicate vomiting, in addition to gastric protectors.

If pain management does not respond to analgesics, the specialist will place a ureteral catheter (JJ catheter) to resolve the urinary obstruction and thus control the pain.

In the event that the calculations need to be fragmented to facilitate their elimination, lithotripsy shall be carried out, Medical procedure in which shock waves are used for the decomposition of the stone. Other possible approaches are surgical, almost all endoscopically: ureterorenoscopy, intrarenal retrograde surgery and percutaneous nephrolithotomy, procedures that are indicated depending on the size, location and anatomy of the urinary tract.

At Uros Associats we have an expert team in the management of urinary lithiasis. Our management is multidisciplinary, we have urologists, nephrologist and a specialist in Nutrition for a better control of your disease. . We also focus on prevention, setting regular check-ups in consultation to determine alterations that can be resolved in time, and thus minimize the chances of recurrence or complications. In case the treatment of your stone is necessary we can offer you all the Minimally Invasive techniques available today: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL or LEOC), RIGID OR FLEXIBLE URETEROSCOPY, RETROGRADE INTRARENAL SURGERY (RIRS) AND PERCUTANEOUS SURGERY (PERCUTANEOUS NEPHROLITHOTOMY OR NLP).

Chronic pelvic pain

Chronic pelvic pain is pain that occurs in the area below the navel and between the hips and lasts six months or longer. It can have several causes, and be a symptom of another disease or be a condition in itself.

If chronic pelvic pain seems to be caused by another medical problem, treating that problem may be enough to relieve the pain.

However, many times it is not possible to identify a single cause of this pain. If this is the case, the goal of treatment is to reduce pain and other symptoms and improve quality of life.

Symptoms

Chronic pelvic pain is usually described as follows:

• Intense, constant pain
• Pain that comes and goes (intermittent)
• Stabbing pains or cramps
• Pressure or heaviness in a deep area of the pelvis
• Pain during sex
• Pain with bowel movement or urination
• Pain when sitting for prolonged periods of time

The discomfort may intensify after standing for long periods and ease when you lie down. The pain can be mild and annoying or it can be so severe that you miss work, can’t sleep, or can’t exercise.

Aetiology

Chronic pelvic pain is a complex condition that can have multiple causes, constituting a symptom of several medical conditions. For example, it is possible for a woman to have endometriosis and interstitial cystitis, both pathologies can cause chronic pelvic pain.

Some of the causes of chronic pelvic pain can be:

• Endometriosis. This is a condition in which tissue from the lining of the uterus grows outside the uterus. These tissue deposits respond to the menstrual cycle, as does the uterine lining, i.e., thickening, rupturing, and bleeding, as hormone levels rise and fall. Because this takes place outside the uterus, blood and tissue cannot leave the body through the vagina. Instead, they remain in the abdomen, where they can lead to painful cysts and fibrous bands of scar tissue.
• Musculoskeletal problems. Disorders that affect bones, joints, and connective tissues (musculoskeletal system), such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernias, and can lead to recurrent pelvic pain.
• Chronic pelvic inflammatory disease. This can happen if a long-term infection, usually sexually transmitted, causes scarring that affects the pelvic organs.
• Ovarian remains. After surgical removal of the uterus, ovaries, and fallopian tubes, small vestiges of the ovary may accidentally remain, which could then lead to painful cysts.
• Fibroids. These noncancerous uterine growths can cause pressure or a feeling of heaviness in the lower abdomen. In rare cases, they cause sharp pain.
• Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome, such as inflammation, constipation, or diarrhea, may be the source of pelvic pain and pressure.
• Painful bladder syndrome (interstitial cystitis). This condition is associated with recurrent bladder pain and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may temporarily give way when you urinate.
• Some doctors believe that dilated varicose veins (varicose veins) around the uterus and ovaries can cause pelvic pain. However, other doctors doubt that pelvic congestion syndrome is the cause of pelvic pain because most women with dilated veins in the pelvis do not have associated pain.
• Psychological factors. Depression, chronic stress, or a history of sexual or physical abuse can increase the risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional suffering. These two factors often create a vicious circle.

Diagnosis

Figuring out what’s causing chronic pelvic pain often involves a process of elimination because there are so many disorders that can cause pelvic pain.

In addition to a detailed interview about your pain, your personal medical history and family history, your doctor may ask you to keep a diary of pain and other symptoms.

Tests or exams your doctor may order include:

• Pelvic exam. It may reveal signs of infection, abnormal growths, or tight pelvic floor muscles. The doctor checks for areas of tenderness. Let your doctor know if you feel any discomfort during this test, especially if the pain is similar to what you’ve been feeling.
• Laboratory analysis. During the pelvic exam, your doctor may order lab tests to check for infections.
• Echography. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus, or fallopian tubes.
• Other imaging tests. Your doctor may recommend abdominal X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans to help detect abnormal structures or growths.
• Laparoscopy. During this surgical procedure, the doctor makes a small incision in your abdomen and inserts a thin tube connected to a small camera (laparoscope). The laparoscope allows the doctor to look at the pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful for detecting endometriosis and chronic pelvic inflammatory disease.

Finding the underlying cause of chronic pelvic pain can be a lengthy process and, in some cases, a clear explanation may never be found.

However, with patience and open communication, you and your doctor can develop a treatment plan that will help you live a full life with minimal discomfort.

Treatment

The goal of treatment is to reduce symptoms and improve quality of life.

If your doctor can determine a specific cause, treatment will focus on that cause. However, if it is not possible to identify a cause, treatment will focus on controlling pain and other symptoms. In many cases, the optimal approach involves a combination of treatments.

Drugs

• Analgesics. It is a symptomatic treatment that helps improve the clinic although they do not treat the cause of chronic pain.
• Hormonal treatments. Some women find that days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications can help relieve pelvic pain.
• Antibiotics. If the source of the pain is an infection, your doctor may prescribe antibiotics.
• Antidepressants. Some types of antidepressants may be helpful in relieving chronic pain. Tricyclic antidepressants, such as amitriptyline and others, appear to have analgesic and antidepressant effects. They can help improve chronic pelvic pain even in patients who do not have depression.

Other therapies

Your doctor may recommend specific therapies or procedures as part of treatment for chronic pelvic pain. These may include the following:

• Physiotherapy. Stretching exercises, massage, and other relaxation techniques can improve chronic pelvic pain. A physical therapist can help you with these therapies and develop strategies for coping with pain. Sometimes specific pain points are treated with a medical instrument called transcutaneous electrical nerve stimulation. Transcutaneous electrical nerve stimulation sends electrical impulses to nearby nerve pathways. It may also be helpful to use a psychological technique called biofeedback, which helps you identify areas of tight muscles so you can learn to relax those areas.
• Neurostimulation (stimulation of the spinal cord). This treatment involves implanting a device that blocks nerve pathways so that the pain signal cannot reach the brain. It may be helpful, depending on the cause of the pelvic pain.
• Trigger point injections. If your doctor finds specific points where you feel pain, you may benefit from injections of numbing medication into those painful spots (trigger points). The medication, usually a long-acting local anesthetic, can block pain and relieve discomfort.
• Psychotherapy. If pain may be intertwined with depression, or any type of psychological disorder, you may find it helpful to talk to a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback. Regardless of the underlying cause of the pain, psychotherapy can help you develop strategies for dealing with pain.

Surgery

• Laparoscopic surgery. If you have endometriosis, your doctor may remove adhesions or endometrial tissue through laparoscopic surgery.
• Hysterectomy. In rare and complicated cases, your doctor may recommend removing your uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy). Undergoing this intervention has significant health consequences. Your doctor will discuss the risks and benefits in detail before recommending this option.
• Transurethral bladder resection. In some pathologies, such as interstitial cystitis, it is sometimes useful to resect endoscopically the lesions that are in the inner lining of the bladder and that are associated with chronic pain.
• Intravesical injections. In some cases, the injection of various substances into the mucosa and bladder muscles, such as Botox and some anti-inflammatories, is very decisive. This procedure is performed endoscopically, under anesthesia.
• Anesthetic block of the nerves of the pelvis. In cases where it is identified that the pain comes specifically from the trigger points where sensitive nerves of the pelvis pass, the doctor may indicate the anesthetic block of these points, which would reduce the painful sensations of that area. Sometimes it is necessary to carry out this procedure in the operating room.

Pain Rehabilitation Program

You may need to try a combination of treatment approaches before you find the best option for you. If applicable, you may need to consider entering a pain rehabilitation program. In Uros Associats we have the support of the Pelvic Floor Rehabilitation section of the Teknon Clinic. They are medical specialists and nurses highly trained in stretching, biofeedback and relaxation-stimulation therapies.

Lifestyle

Chronic pain can significantly affect your daily life. When you feel pain, you have trouble sleeping, exercising, or performing physical tasks.

Chronic pain can also cause anxiety and stress, both of which in turn can make pain worse.

Relaxation techniques can help relieve tension, reduce pain, calm emotions, and induce sleep. You can learn many techniques on your own, such as meditation and deep breathing.

Multidisciplinary approach

Depending on the suspected cause of pain, your doctor may refer you to a digestive system specialist (gastroenterologist), gynecology specialist, or musculoskeletal pain specialist (physiatrist or physical therapist).

How to prepare for your appointment

• Make a list of all the signs and symptoms you’re experiencing. He mentions those that seemed unrelated to the reason for the consultation.
• Write down key medical information. Include major stressors or recent changes in your life.
• Make a list of all the medications you take and the dosages you take. Indicate prescription and over-the-counter medications, vitamins or other supplements you’re taking.
• It’s a good idea to bring a family member or friend. Sometimes it can be difficult to remember all the information provided during a visit. Someone who accompanies you may remember some fact that you forgot or did not notice.
• Prepare questions. Preparing a list of questions can help you not forget any.