Causes of renal colic, symptoms and treatment. What are the symptoms of renal colic in women? What causes renal colic

Renal colic in itself is not a disease, representing a symptom that indicates quite pronounced manifestations that something is wrong in the body. The main symptom accompanying this condition is pain. Renal colic, the first aid in which is focused specifically on the elimination of this pain, occupies an "honorable" second place in terms of the frequency of its own appearance, following the manifestations of acute appendicitis.

Causes of renal colic

The following conditions are distinguished as the causes of renal colic:

• urolithiasis disease;
• disorders in mineral metabolism;
• pyelonephritis;
• nephroptosis;
• hydronephrosis;
• tumor formations in the kidney area;
• diseases associated with the functions of the prostate gland, etc.

In general, about 38% of the total number of cases of this condition, the causes of renal colic cannot be determined. Meanwhile, the most common cause is determined by the relevance for the patient of urolithiasis, in which there is a blockage of the lumen of the ureter by a stone.

Renal colic, the first aid for the appearance of which we will discuss below, requires contacting a doctor after it appears, and it is important to do this in any case, even if the pain has gone away on its own and quickly enough. The fact is that this condition may indicate the presence of one or another, often extremely dangerous disease, the treatment of which should be started immediately. Such diseases include, for example, tumors (whether it is a benign tumor formation or a cancerous formation).

In the case of the formation of stones in the kidney and the appearance of renal colic against the background of nephrolithiasis, this condition is accompanied first by pain, and then by the appearance of blood in the urine during urination.

Renal colic, provoked by a blood clot of a dense consistency, as a result of which a blockage of the ureter occurred, initially determines the presence of blood in the urine, and after that, renal colic itself develops.

Symptoms of renal colic

Renal colic can appear quite suddenly, and even against the background of a person’s normal well-being. In addition, its peculiarity lies in the severity of manifestations that accompany the state as a whole. So, the patient has a sharp pain, concentrated in the lumbar region, this pain has a pulsating character, and only by changing the position of the body in this situation it will not be possible to reduce its intensity. When taking any position of the body, the pain does not subside, the patient is in a restless state, reaching almost a state of pain shock.

Often, renal colic is accompanied by symptoms indicating intoxication, which manifests itself in severe tremor (trembling) of the limbs, nausea and vomiting, general weakness and impaired consciousness. In addition, there are urges to urinate, which are also very painful.

In almost all situations, renal colic is accompanied by intestinal paresis, which occurs at the reflex level as a reaction to severe pain in the area under consideration. This manifests itself in the form of difficulty in the discharge of gases, constipation, bloating.

Renal colic: first aid

As we have already noted, renal colic, when it occurs, requires a mandatory visit to a doctor, it is necessary to call it, despite how intense the pain sensations relevant to this condition are and how long the attack itself lasts. Signs of renal colic can often imply completely different diseases, in which it is simply impossible to do without emergency specialized assistance. It can be appendicitis or ectopic pregnancy, an attack of cholecystitis or pancreatitis, as well as any other pathology.

Often, renal colic is mistakenly diagnosed as intestinal obstruction, and this is quite justified - the clinical picture in both cases is almost identical.

Providing first aid for renal colic requires, first of all, the conviction that the point here is really in this condition, and not in something else. If this is any acute disease, heat in it is completely contraindicated, which cannot be said about renal colic, in which, on the contrary, it is necessary. Accordingly, to determine a specific condition, an assessment is made of the signs of renal colic, which is described somewhat above, in particular, it is necessary to carefully consider the manifestations of pain, which, in the state of interest to us, is cramping. Also taken into account is such a factor as frequent urination.

In particular, first aid for renal colic is to provide the victim with warmth. However, if he has a high temperature and impaired consciousness, this item is skipped as a measure of implementation.

If the patient has a normal temperature and really renal colic, then the most effective first aid measure is a hot bath, which must be taken in a sitting position. It must be filled with water as hot as the maximum a person can bear to heat it.

Again, there is a contraindication to this. So, if the victim of renal colic is an elderly person or a person who has one or another serious disease associated with the functions of the cardiovascular system, as well as a person who has previously had a heart attack or stroke, then a hot bath in these options is unacceptable. In such cases, the first aid for renal colic is to limit heat before using a heating pad on the lumbar region. In addition, mustard plasters can also be used, they should also be placed in the area of ​​\u200b\u200bthe kidneys.

Acute pain in the abdomen and lower back that a woman may experience is one of the most dangerous symptoms. It is a sign of many diseases: each of them is extremely serious and requires medical intervention. But if a person has suffered from pathologies of the urinary system for a long time, the cause of the development of acute pain syndrome is renal colic. It is diagnosed in 80% of women admitted to various departments of medical institutions. That is why it is so important to know the first manifestations of the disease and the rules for providing assistance before the arrival of doctors.

What is renal colic in women

Renal colic is a pathological condition that is most often provoked by the release of a stone from the kidney and is accompanied by a pronounced spasm of the smooth muscles of the excretory system organs and an acute pain syndrome. First aid for such an ailment should be provided immediately, otherwise it can lead to disastrous consequences for a woman. By itself, renal colic is not a disease, but only complicates most of the ailments of the excretory system.

Symptoms

The main clinical manifestations of the pathological condition can be called:

• sharp, stabbing pain in the lumbar region lasting up to several hours, which can radiate to the pubis, abdomen, groin, thigh, and also be felt both on the right and on the left;
• an increase in body temperature to 38–39 degrees Celsius;
• nausea and vomiting without connection with meals;
• violations of the discharge of urine and feces;
• severe dizziness and;
• sleep changes (insomnia, frequent awakenings);
• loss of appetite;
• almost complete immobility.

Features of the pathological condition in pregnant women

During the period of bearing a child, the body becomes extremely sensitive to influences both from the outside and from the inside. That is why pregnant women feel an attack of renal colic much more acutely. Since the enlarged uterus, in which the baby grows and develops, fills the entire abdominal cavity, the kidneys and ureters with the bladder experience more pressure. In most cases, doctors encounter such a pathology in the third trimester.

In practice in gynecology, the author studied the history of a woman in labor who suffered an attack of acute renal colic in the eighth month of pregnancy. It was accompanied by severe toxicosis: the woman had a fever, she was constantly sick, her back hurt very badly, and the baby was pushing much more actively than usual. According to the ultrasound examination, a huge stone was found in the right kidney, which caused the development of colic. On that day, the patient underwent two operations: to remove the pathological formation and a caesarean section. The patient and the baby felt satisfactory and were discharged after three weeks.

Video: manifestations of renal colic

Causes and factors for the formation of pathology

More than a million women around the world develop this disease every year. Most often, pregnant and lactating mothers, adolescents and people over 60 years of age suffer from renal colic.

Anything can provoke the formation of pain: prolonged stress, fear, a sharp push, riding in transport or active physical activity.

Causes and factors for the development of renal colic:

1. Urolithiasis is a pathological condition that is associated with the formation of stones in various parts of the excretory system that disrupt the normal excretion of urine. They can also injure the mucous membrane, to which the organ responds with a pronounced spasm.
2. Inflammatory diseases: cystitis, urethritis, glomerulonephritis. They are formed under the action of bacterial microorganisms and are accompanied by severe soft tissue edema.
3. Poisoning by various substances, which may include industrial compounds, narcotic and medicinal preparations, poisons of plants, fungi or animals. They have a toxic effect on the entire body as a whole, but it is the kidneys that most often suffer.

Diagnosis of the disease and its differentiation

Renal colic has a clinical picture of an acute pain syndrome, which is accompanied by severe muscle spasm. Quite often, this ailment is confused with the following pathological conditions:

• cholecystitis;
• appendicitis;
• ectopic pregnancy;
• rupture of the fallopian tube;
• acute endometritis;
• an attack of gastritis or peptic ulcer;

To determine the cause of pain, doctors resort to laboratory and instrumental research methods.

Immediately upon admission to the hospital, a general urine test is taken from the patient: after hygiene of the genital organs, a small amount of urine is collected in a special container. Then she goes to the laboratory, where they study her physical characteristics and cellular composition. Normally, urine has a straw-yellow color, is transparent and does not contain pathological impurities. With renal colic, there is a pronounced clouding and even redness of the urine (if the stone damages the soft tissues), it contains sand and blood clots. The number of leukocytes, epithelium and cylinders increases, which indicates an incipient inflammation.

Next, each patient must undergo an ultrasound examination of the excretory system. The doctor examines the condition of the kidneys, ureters and bladder, simultaneously assessing their patency. Thus, it is possible to detect many stones, bacterial emboli and foreign bodies that can cause the development of pain. And also ultrasound allows you to choose the best tactics to eliminate the disease.

Rules for the treatment of renal colic in women

Therapy for an acute attack of pain consists of two stages:

• the first is to relieve spasm and relax the muscles of the urinary system;
• the second is aimed at eliminating the cause that provoked the development of the disease.

Currently, conservative treatment is widely used (includes a strict diet, the use of drugs) and surgical: elimination of kidney stones.

Usually, after a few hours from the moment of development of renal colic, the patient is admitted to a hospital (department of urology or nephrology), where doctors carry out all the most important tests and make a verdict on the need for surgical intervention.

First aid for the development of a pathological condition

If an acute attack of renal colic has taken you or your loved ones by surprise, there is no need to panic. It is necessary to call an ambulance as soon as possible and describe the condition of the victim to the dispatcher, not forgetting to give the address of his location. The next step is to get back to action.

Many people believe that a heating pad is the most effective way to get rid of an attack of acute pain. Its use can be justified only in cases where you know for sure that the cause of colic was the development of not an inflammatory disease, but another pathology (for example, the movement of a stone). If the patient has a similar disease, it is necessary to abandon the use of any warm-ups.

Algorithm of actions in an emergency:

1. Reassure the victim. To do this, you can give her to drink a small amount of clean non-carbonated water in small sips. It is forbidden to use juices, carbonated drinks, alcohol, coffee and energy drinks. It is also recommended to stop eating in the next few hours.
2. Gently move the patient from a hard surface to a softer one. If she refuses to leave her seat, it may be wise to spread a blanket or blanket over the bed to avoid hypothermia.
3. Offer the victim the available antispasmodic drugs (No-shpu, Spazgan, Drotaverine) in the form of tablets. Independently carry out intravenous and intramuscular injections is prohibited.
4. If the patient has no history of inflammatory diseases, you can place the victim in a bathtub with warm water up to the waist. The best option would be to apply a heating pad or any other warm object to the lumbar region.

Video: first aid to a person suffering from renal colic

Table: drug therapy of the disease

Photo gallery: pharmaceuticals used in ailment

Cystone removes sand from the kidneys Baralgin relaxes the pelvic muscles Ibuprofen relieves inflammation

As with other diseases, the body spends a huge amount of energy on recovering from a painful attack and eliminating the negative effects of renal colic. That is why a special diet is prescribed for all patients at risk of developing pathology, which will avoid many provoking factors. The most important principles of proper nutrition:

• rejection of preservatives;
• small portions of food weighing no more than three hundred grams;
• fragmentation of food intake;
• obligatory presence of breakfast, lunch, dinner and two snacks;
• use only fresh products for cooking;
• minimal use of salt and hot spices;
• all food should be stewed, boiled or baked;
• fried foods are completely excluded from the diet;
• every day the patient should drink at least two liters of pure non-carbonated water;
• slow absorption of the dish and its thorough chewing will help to better taste the taste.

What products need to be removed:

• canned food (fish, meat, fruits and vegetables);
• chips, crackers and other similar snacks;
• marmalade and chocolate;
• store-bought pastries with protein cream;
• fatty meats and fish, lard;
• sausage and wieners;
• processed cheese;
• alcohol;
• carbonated drinks;
• packaged juices and fruit drinks;
• coffee and chicory;
• energy drinks and other stimulants;
• fast food (hamburgers, nuggets, french fries);
• semi-finished products;
• fast food (noodles, mashed potatoes, cereals);
• seeds;
• home salting.

Photo gallery: junk food

Fast food is rich in fats and fast carbohydrates Canned food contains many additives Chips are high in salt and trans fats.

Be sure to add to your daily diet:

• vegetables and fruits (fresh and in the form of stews, salads, snacks);
• berries (as a dessert and the basis for dishes);
• homemade compotes and fruit drinks with a minimum sugar content;
• lean meat (chicken, turkey) and fish (pollock, hake, crucian carp);
• greens (spinach, dill, celery, basil, cilantro);
• milk, yogurt without fillers, cottage cheese, kefir, fermented baked milk, sour cream;
• homemade oatmeal cakes;
• nuts and dried fruits;
• green and black tea without additives;
• natural honey;
• cereals on the water and cereals (buckwheat, oatmeal, rice, barley, millet, semolina);
• legumes and peas (lentils, chickpeas).

Photo gallery: healthy food

Honey is a natural sweetener
Grains are rich in healthy carbohydrates Green tea gives energy for the day

Folk recipes as an additional therapy

Even before the advent of traditional medicine, many diseases of the genitourinary system were treated with various plants and herbs. Currently, they can also be used as adjunctive therapy, as they are excellent for managing the main symptoms. However, in no case should you abandon traditional medicine: only it can eliminate the cause of the development of renal colic.

The author of the article was present at a medical meeting, where the history of one patient was considered in detail. A woman in the last stages of pregnancy with chronic urolithiasis constantly suffered from severe attacks of renal colic, which could be repeated regularly throughout the day. She read on the Internet that most drugs cross the placenta and can have a negative effect on the fetus. That is why the patient neglected all pharmaceuticals and was treated only with decoctions and infusions. Unfortunately, after a few days of such therapy, the stone damaged the ureter and caused a powerful attack of pain, which provoked premature birth. Immediately after the birth of the baby, the victim was taken to the urology department and operated on.

Such recipes are used as an aid:

1. Grate three large ginger roots. Throw them into a pot with four liters of hot water and cook for half an hour, stirring constantly. Then you need to remove the container from the heat, cool, strain through a sieve and pour into small bottles. It is recommended to drink two glasses before each meal. Ginger has a pronounced anti-inflammatory and antiseptic effect, which contributes to the death of many pathogenic microorganisms. The course of treatment consists of twelve procedures with an interval of three days.
2. Four bags of pharmacy chamomile brew in a glass of boiling water. After cooling, drink (recommended before going to bed). It is believed that this plant has a calming effect, reducing the activity of the nervous system. This, in turn, reduces hyperexcitability, and the risk of developing renal colic is reduced several times. Therapy lasts at least three weeks.
3. Mix one hundred grams of lemon balm with a tablespoon of mint and lavender. Pour the herbs with a liter of boiling water, then insist for a day. Use a sieve to remove excess raw materials and drink one glass before meals. This infusion helps relieve spasm and prevents relapses.

Photo gallery: natural remedies for an acute condition

Ginger Root Kills Bacteria Chamomile has a sedative effect Melissa relieves spasm

Treatment of pathology by surgical methods

If the cause of sudden renal colic is a stone, it is necessary to remove it and free the lumen of the organ. Usually, stones not only impede or completely block the normal passage of urine, but also injure the walls of the ureter, causing a reflex spasm. At the same time, even after the introduction of relaxing drugs, the stone continues to have a damaging effect, which leads to the need to remove it so that colic does not recur.

The choice of treatment method is largely determined by the patient's condition, the presence of other chronic diseases, as well as age. Elderly people, pregnant women and children are more likely to undergo low-traumatic surgeries.

What are the options for surgical treatment?

1. Contactless stone removal. Indicated for small formations. The patient is located on the couch in the operating room, after which light anesthesia is introduced and the exact location of the foreign body is determined under ultrasound control. With the help of a special device, remote crushing of stones located in the lumen or in the walls of the organ is carried out. They are gradually broken down into small particles that are excreted from the body along with urine.
   Non-contact lithotripsy allows you to quickly and painlessly remove stones
2. contact lithotripsy. It is carried out under local anesthesia, it is the introduction into the urinary canal of a woman of a special instrument - a ureteroscope. With the help of an ultrasound device, the doctor monitors the progress of the device towards the stone, and upon reaching the goal, launches the program. The conglomerates are crushed with the help of shock waves of high frequency and force. This technique is used when the pathological formation is in the lower part of the ureter.
   With contact lithotripsy, the stone is crushed directly in the ureter.
3. Percutaneous lithotripsy. It is carried out if the stone is located in the pyelocaliceal system of the kidneys. A narrow and long needle is inserted through a small hole in the lumbar region. Gradually, she reaches the organ and pierces its capsule, under the supervision of a doctor, penetrating directly to the stone. Its crushing is also carried out by means of a shock wave.
   Percutaneous (percutaneous) nephrolithotomy is performed when the stone is located in the pyelocaliceal system of the kidneys

The recovery period after all treatment techniques is from two to fifteen days. The first few days the patients are under the supervision of a doctor in the Department of Nephrology or Intensive Care. After discharge, they are prescribed a serious diet and given recommendations for taking medications. Such patients will need to undergo a medical examination every six months, which will allow tracking the dynamics of the development of the disease.

Treatment forecasts and possible complications of the disease

Renal colic, like any other acute condition, disappears within fifteen to twenty minutes after the introduction of a relaxing agent. If this does not bring the desired effect, the injection is repeated. With competent help, the patient almost immediately comes to her senses and stops complaining about severe pain. However, do not forget that renal colic is prone to recurrence, especially if the patient violates the diet and does not take drugs intended for the treatment of the underlying ailment.

In his practice, the author came across a patient who for twelve years suffered from constantly recurring pain attacks, but did not seek help from a doctor, preferring to wait them out on her own. She had a history of urolithiasis suffered twelve years ago, while the woman did not follow the diet, eating a large amount of fatty, fried and salty foods. This behavior led to the most serious consequences - the removal of the kidney, and the patient is constantly on hemodialysis (a procedure that provides artificial blood purification by passing it through a special filter apparatus). That is why doctors strongly recommend seeking help as early as possible.

The main complications and negative consequences of renal colic:

1. The death of soft tissues. Due to prolonged vasospasm, hypoxia gradually develops - a pathological condition in which cells suffer from a lack of oxygen supplied with arterial blood. If the compression lasts longer than fifteen minutes, ischemia and necrosis develops - the death of the renal substance. Gradually, dead tissues are replaced by connective fibers that cannot perform the function of filtering and reabsorption of fluid. Treatment of this pathology is carried out only surgically.
2. Urine infection and the development of inflammatory diseases of the pelvic organs. In the event that the cause of the formation of renal colic is a stone, various pathogenic microorganisms gradually accumulate at the site of damage. They actively multiply, as a result of which part of the fluid below the site of spasm becomes infected. When it is thrown back into the kidney, the following inflammatory processes can develop: pyelitis, pyelonephritis, nephritis. To avoid joining a secondary infection, doctors use antibacterial drugs if the colic has lasted more than an hour.
3. Chronic disease (failure) of the kidneys is a serious pathological condition, which is characterized by a violation of the anatomical and physiological features of the urinary system. The disease is often associated with prolonged and painful relapses of renal colic. Due to the death of parts of the organ and their replacement with connective tissue, the excretory system cannot cope with the regular load of removing toxins from the body. A person is constantly exposed to harmful metabolic products, which can provoke a coma and even death.
4. Premature birth with the development of renal colic during pregnancy. Acute pain is a strong irritant for the organism of the expectant mother, which can provoke the discharge of water and stimulate the contractile activity of the uterus. This contributes to the early birth of the fetus. Such children often suffer from neonatal jaundice and may lag behind their peers in development in the first years of life, after which the situation returns to normal.

Photo gallery: the main complications of an acute condition

The death of the kidney leads to its removal Jaundice may occur due to premature birth Pyelonephritis is an inflammatory disease, after which scars remain in the tissue of the organ

Various ways to prevent renal colic

By itself, this ailment is a pronounced signal for the body, which calls for attention to the state of health. Renal colic is a symptom of an acute or chronic disease that requires treatment. Twenty-first century medicine, unlike its predecessor, focuses on the prevention of pathological conditions and the prevention of their development, and not on treatment, as was customary in the past. That is why it has become so popular to create a health cabinet in various medical institutions, where people can get the necessary information. All preventive measures aimed at protecting women from the formation of renal colic are divided into collective and individual. The former are carried out with the participation of doctors and pharmacists, while the latter are carried out by the patients themselves or their relatives.

While working in the Department of Nephrology, the author of this article and his colleagues participated in the organization of an open seminar on the issues of differential diagnosis of renal colic. The event was held on the territory of the Medical University, and everyone could get to it. Professors and teachers gave a lecture to the population about the symptomatic manifestations and important signs of the disease, taught to distinguish colic from appendicitis, ectopic pregnancy and acute cholecystitis. Students at this time clearly showed the sequence of providing first aid to the victims, at the same time dwelling on the main mistakes. At the end of the seminar, testing was carried out, which showed the awareness of the population in matters relating to the development of renal colic. It was found that 80% of listeners have fully mastered the material and will perfectly be able not only to distinguish one ailment from another, but also not to get confused in an emergency.

How to prevent the development of renal colic in women:

1. Do not break the diet recommended by your doctor. Most fast food products (semi-finished products, instant porridge and noodles) contain a huge amount of modified fats and carbohydrates, which are poorly digested by the gastrointestinal tract and are practically not excreted by the kidneys. It has been scientifically proven that the consumption of hamburgers, french fries and carbonated drinks contributes to the formation of protein-fat and salt conglomerates, which can cause the development of renal colic. Insufficient consumption of clean water also leads to acid-base imbalance. Patients with kidney disease need to adhere to the prescribed diet at all times: even a slight deviation can provoke a shift in electrolyte balance, and excess fluid will begin to accumulate in the body.
   Semi-finished products contain a large amount of salt, harmful to the body
2. See your doctor regularly and don't put off treating chronic diseases. Few people know that even those ailments that have been in remission for many years and have not manifested themselves in any way need strict control. A long-forgotten urolithiasis or pyelonephritis can remind of itself after a viral or bacterial infection. That is why it is so important to take regular blood and urine tests, as well as visit your doctor.
3. Spend at least three days a week exercising. Sport not only strengthens the body, but also prevents the development of many pathogenic infections in it. With a sedentary lifestyle, the risk of becoming obese, diabetes mellitus, hypertension and urolithiasis is much higher, which leads to the development of colic in the kidneys. Doctors strongly recommend abandoning the usual leisure time in front of a computer and TV, replacing it with visiting the gym, dancing, wrestling, and yoga.
   Yoga is a great form of physical activity for those who want to be in harmony with themselves.
4. Observe intimate hygiene of the vagina and perineum. Most of the bacteria that provoke the development of inflammatory diseases live on the surface of the skin or mucous membranes. If the integrity of the protective barrier is violated, they easily penetrate the body, contributing to the formation of ailments. That is why it is so important to take a daily hygienic shower with special soap: it will not disturb the fragile biocenosis of the vagina.
5. Get rid of bad habits. Abuse of alcohol, nicotine or drugs has a destructive effect on the body of any person, but women suffer much more. This is directly related to their less resistance to environmental factors. Bad habits slow down the metabolic processes in the human body, and toxins damage the fragile kidney system, provoking the development of colic.
6. Do not take medicines without a doctor's prescription. Any remedy has a certain dosage, which is calculated based on the age and weight of the patient. An excessive amount of the drug can cause serious poisoning and provoke the development of renal failure in women of any age. Patients with chronic ailments need to carefully monitor the compatibility of one drug with another, since the mixing of different substances provokes certain biochemical reactions in the body.

Renal colic is an unpleasant and in some cases even a dangerous condition that a woman can develop against the background of various diseases or poisonings. Remember that when you or your loved ones are faced with this ailment, you should not panic or be scared: all the consequences are easily eliminated if you correctly provide first aid. So that renal colic never bothers you again, you should definitely start treating the underlying disease: this is the only way to protect yourself from new attacks. Do not forget about the rules of prevention and basic medical recommendations to protect yourself from the disease.

Renal colic is an acute attack of discomfort, which is formed against the background of blockage of the urinary tract, a violation of the outflow of urine from the kidney to the bladder. Trouble requires urgent medical attention, in order to avoid the occurrence of serious complications.

Colic in the kidney area is the most common pathology that is addressed to a nephrologist. The prevalence of an unpleasant syndrome is associated with a large number of patients suffering from the root cause of the phenomenon - urolithiasis, since renal colic is often provoked by blockage of the urinary canals with stones of various sizes.

Probable causes of pathology

About 90% of all cases of renal colic occur during. The exact causes of the formation of the disease are not yet known to doctors. It is believed that the disease appears against the background of the influence of several negative factors.

The likelihood of developing urolithiasis, therefore, the appearance of renal colic, is associated with the age of the patient. The risk group includes children, elderly ladies. The peak of diagnosing the disease falls on 30-50 years. Women suffer from the disease less often than men, which is due to the negligent attitude of the stronger sex to their health, the presence of many bad habits.

The remaining 10% of the total mass of patients suffer from renal colic against the background of the course of more serious pathologies not associated with urolithiasis:

• the course of the inflammatory process in the pelvis of the kidney (in acute and chronic form). Blockage of the urinary tract occurs due to the accumulation of a large amount of pus, disruption of the excretory system;
• kidney cancer. The lumen is closed by pieces of the tumor, blood clots;
• various injuries in the kidney area lead to hematomas, the urinary canals are closed by blood clots;
• . Unpleasant sensations are provoked by a fragment of a caseous focus;
• "wandering kidney" (omission of an organ). In such cases, colic occurs against the background of an inflection of the ureter, unpleasant sensations intensify during running, a sharp change in body position;
• gynecological diseases. Rupture of the fallopian tube, a cyst in the ovary can lead to pain in the lumbar region;
• the course of acute neurological diseases (sciatica, herniated disc). The symptoms of these diseases are similar to attacks of renal colic.

Depending on the root cause of the appearance of discomfort, the physician must build a further plan for the treatment of renal colic in women. It is almost impossible to independently identify a negative factor without diagnostic manipulations.

Renal colic code for ICD 10 - N23.

First signs and symptoms

Pathology is the most severe type of pain that does not decrease with a change in body position. An attack of renal colic appears suddenly, a person may not be aware of the presence of any health problems.

Signs of renal colic include:

• pain is often localized on one side of the gingerbread department (both kidneys are rarely affected at the same time);
• unpleasant sensations are paroxysmal in nature;
• pain worsens during urination;
• sensations can spread to the perineum, inner thigh;
• urine may include blood clots, impurities of pus, which indicates damage to the urinary tract;
• serious pathological conditions are characterized by a sharp increase in the body, blood pressure;
• many patients complain of vomiting, stool disorders;
• the volume of urine is significantly reduced against the background of blockage of the excretory channels;
• with problems of a gynecological nature, renal colic is accompanied by bleeding from the vagina, pain in the uterus, appendages.

Often they come out with blood. After removing the blockage of the excretory channels, the pain usually subsides, but this does not mean that you need to forget about the incident. Any pathology requires diagnosis, timely therapy.

Note! The pain attack can be so severe that some women lose consciousness, the skin becomes pale, blood pressure drops significantly. In such a situation, you should immediately call an ambulance.

Diagnostics

A number of specific studies will help to make the correct diagnosis, prescribe the appropriate course of therapy:

• general examination of the patient, the study of complaints. Localization of discomfort, accompanying signs may suggest what is the cause of the pathology;
• the patient's history. In most cases, severe renal colic appears after improper treatment or lack of therapy for urolithiasis. Data on all existing ailments in the patient are recorded in his medical record;
• family history. If urolithiasis is diagnosed in the next of kin of the patient, the probability of a similar disease in the patient himself is more than 60%;
• laboratory tests (blood test, urine test of the patient), other studies (, nearby organs, if necessary, a woman is sent to an appointment with a gynecologist).

The set of diagnostic manipulations is aimed at identifying the cause of the patient's ailment, finding the best method of treatment.

General rules and methods of treatment

What to do with renal colic? Depending on the root cause that caused the pain, the treatment regimen varies. Avoid self-medication follow the doctor's recommendations.

First aid for renal colic

• ensure complete rest, any movements (even walking) increase pain;
• thermal procedures (warming up the lumbar region) are allowed only if there are no inflammatory processes. If the cause of the appearance of the pathology is unknown, use antispasmodics, medications help to relax the muscles, relieve unpleasant symptoms;
• before the ambulance arrives, you can take analgesics (remember the name of the medicine, the dosage, tell the doctors about this data).

On a note! The use of any liquids leads to a deterioration of the situation and negative consequences.

When is hospitalization necessary?

Inpatient treatment is necessary in the following cases:

• increased body temperature, blood pressure;
• lack of urine output;
• loss of consciousness, blood / pus in the urine.

Specific therapy depends on the disease that provoked discomfort. In most cases, doctors diagnose urolithiasis, treatment is aimed at removing stones, preventing their reappearance.

Medications

Effective medicines:

• taking antispasmodics and painkillers for renal colic (No-Shpa, Spazmalgon). Medicines relax the muscles, which promotes the natural removal of stones;
• analgesics (Ketanov, Diclofenac) are used in the course of all diseases, narcotic painkillers are administered only by physicians;
• herbal remedies increase the effectiveness of the two previous groups of medicines (Urocholum,);
• protracted bouts of colic are stopped by novocaine blockades;
• the course of inflammatory processes is a reason to prescribe antibiotics or antiseptics to the patient, corresponding to pathogenic microorganisms that have affected the kidneys or urinary tract of a woman.

The presence of a large number of stones obliges doctors to find a way to crush them. Small stones are crushed with the help of special preparations, devices or instrumental methods. The lack of a positive result leads to the use of surgical methods for removing stones. Operations are also indicated for certain gynecological diseases, kidney cancer, and serious organ damage.

Important! Do not delay the trip to the doctor, limiting yourself to painkillers. Unpleasant sensations are the body's way of asking for help. Refuse self-medication, only a specialist will help identify a negative factor and prescribe the necessary medications.

Diet and nutrition rules

An important role in therapy is played by a change in diet and diet for renal colic:

• consume at least two liters of water a day, it is allowed to take decoctions of chamomile, calendula, mineral water without gas;
• if the cause of the pathological process is not established, exclude chocolate, smoked meats, alcohol, pickles, garlic, mustard, all foods that irritate the mucous membranes from the diet;
• each type of stones requires a specific diet (the specific menu will be indicated by the doctor);
• The number of meals plays an important role. Eat five times a day in small portions, it is strictly forbidden to starve.

After eliminating discomfort, go in for sports, choose light physical activity, such as Pilates. Pay attention to the mode of rest and work, sleep at least eight hours a day. The combination of changes in lifestyle, nutrition will best affect the course of chronic ailments, help to avoid relapses.

Prognosis and possible complications

After the cessation of an acute attack of renal colic, the patient's condition returns to normal, there are slight discomfort in the lumbar region. The prognosis depends on the nature of the disease that provoked the disease, the actions of the physician and the victim himself.

Lack of therapy, negligent attitude to health leads to sharply negative consequences:

• decrease in the functions of the affected kidney, up to the loss of the diseased organ;
• the transition of pyelonephritis to a chronic form;
• formation of ureteral stricture.

Look at the list for cystitis in women and the rules for their use.

The rules for preparing for kidney urography and the procedure are described on the page.

Go to the address and learn about the first signs of pyelonephritis and how to treat the disease at home.

As a prevention of pathology, doctors recommend following simple rules:

• in the absence of any complaints, visit a doctor, take a urine test once a year. The presence of a history of urinary tract diseases obliges the patient to undergo an examination every quarter;
• in the season of watermelons, lean on these berries, cleanse the kidneys of accumulated toxins;
• treat diseases of the genitourinary system and other organs in time;
• if you suffer from urolithiasis, watch your diet, follow a special diet.

Simple rules can protect you from renal colic, the causes that cause them. Take care of your health, if necessary, seek medical help.

Hellish pain for a long time - this is how women describe their condition with renal colic. All about the causes of an attack and about the rules for first aid for renal colic - in the next issue of the column "About Medicine":

Renal colic is a cramping pain caused by spasm of smooth muscles due to problems with urine output. Basically, the symptom develops as a result of blockage of the ureters with stones. ICD code 10–23.

Causes of colic

In about 90% of cases, it becomes a provocateur of renal colic. Until now, medicine does not know exactly why sand and stones form in paired organs. The lesion can be found both on the right and on the left. 15–30% are diagnosed with bilateral urolithiasis.

Main Factors

Manifestations of renal colic are often associated with injury or disease, leading to narrowing or compression of the lumen of the ureter. At the same time, the blockage of the passage has a different localization - the excretory canal itself, the bladder, the renal pelvis.

The provocateurs of renal colic include:

These are far from all provocateurs of the renal clique. A characteristic clinical picture develops due to the intake of sulfa drugs, excessive use of ascorbic acid, problems with the gastrointestinal tract, Paget's and Crohn's diseases. Even barometric fluctuations during a voyage by plane can cause an attack.

Related factors

The risks of developing renal colic are divided into 2 types:

• general;
• private.

The first group includes:

1. Floor. More often, pathology is diagnosed among men.
2. Number of years. People in the 30-50 age group are more susceptible. In children, boys and girls, the elderly, the problem occurs much less frequently.

To the second:

1. Heredity.
2. Profession. Often, pathology is diagnosed in workers of hot shops.
3. Climatic conditions. People living in the northern and southern regions are at greater risk.
4. Active physical activity. Sometimes ICD is detected in athletes.
5. Lack of liquid in the diet, composition of water in the region.
6. Frequent consumption of animal proteins, salty foods, smoked meats, chocolate.
7. Limited level of vitamin A. Causes desquamation of epithelial cells, which become the nuclei of crystals.
8. Lack or excess of vitamin D. This substance affects the ability of calcium to bind oxalic acid in the intestines, which, accumulating, settles in the kidneys and leads to the formation of oxalates. The body needs 600 IU of the vitamin per day.
9. Dehydration. It is noted both against the background of a small supply of moisture, which leads to an increase in the density of urine, and as a result of intensive evaporation through the surface of the skin.

Important! In 55% of patients, attacks of renal colic are included in the family history.

Signs of renal colic in men and women

Symptoms of renal colic appear suddenly in a seemingly healthy person. They are not preceded by special physical activity, the picture is almost independent of external factors.

The duration of signs of renal colic depends on the speed of the stone, it can be measured in minutes and days.

Important! If the clinical picture is observed for more than 5 days, the consequences are irreversible changes in the organs.

After elimination of an attack of renal coli, the malaise quickly disappears. Urine is excreted in a large volume, since during this time there was an accumulation of fluid in the affected kidney.

During pregnancy

The development of renal colic in a pregnant woman in the later stages is often perceived as the onset of childbirth. And the risk of pathology is quite high - during pregnancy, urolithiasis is diagnosed in 0.2–0.8% of patients. At the same time, the conception and development of the baby does not affect the likelihood of the formation of calculi in any way. Most likely, even before this moment, the process of stone formation began, but the pathology proceeded latently, without a pronounced clinical picture.

Most often, symptoms appear in the third trimester:

• cramping pain;
• the presence of blood in the urine;
• stone exit.

The symptomatology is really similar to labor activity and usually the diagnosis of KSD is made already in the hospital. I must say, an attack is quite capable of leading to a discharge of water and the premature birth of a baby.

The main problem is to relieve pain. Pregnant women are prohibited from using most medications, as they lead to negative side effects of fetal development. Heating is also contraindicated. Therefore, treatment is carried out, trying to minimize the risks.

Usually prescribed:

1. Injections of papaverine hydrochloride, 2 ml of a 2% solution, Noshpy, platyfillin hydrotartrate 0.2% subcutaneously.
2. If the attack started at home, you can take 2 tablets of Avisan or 20 drops of Cystenal on a piece of sugar under the tongue - the drugs stop renal colic and at the same time have an anti-inflammatory effect.

Important! It is advisable to immediately call emergency care, since the risk of labor pains and infection with renal colic increases significantly.

In children

At a younger age, the pathology proceeds atypically, which leads to medical errors. You can identify the problem by carefully observing the behavior of the child.

1. Often the baby incorrectly points to the navel as a place of localization of pain. But sometimes the symptom really manifests itself throughout the abdomen.
2. Cries, behaves uneasily, does not allow touching the painful area.
3. Loose stools or constipation present.
4. Bloating of the abdominal cavity due to the accumulation of gases, reflex vomiting are noted.

To make a competent diagnosis, you need to check for back pain, as well as examine muscle tone, especially when it comes to an infant. To do this, they resort to the definition of Pasternatsky's symptom - the fingertips are applied to the kidney area and shake the tissues with them.

But it is worth remembering that this method helps to suggest renal colic, and not make a final diagnosis. A confirmatory result is also obtained in the case of appendicitis with an incorrect location of the process, thrombosis of the vessels of the mesentery, intestinal obstruction. Therefore, a thorough examination in a hospital setting is necessary.

Emergency care stops an attack only if there is no doubt. Before her arrival, parents can independently reduce the pain symptom by placing the child in a bath with a water temperature of 37–39 ̊С. If this measure did not work, apply Noshpa or Baralgin. But it is desirable to know exactly the allowable dosage.

With renal colic, the child is hospitalized. Surgical treatment is not excluded.

Important! The formation of stones in babies is usually triggered by a hereditary factor and illiterate nutrition. If the baby is breastfed, the mother should be careful about her own diet.

Complications

If treated in a timely manner, complications do not develop. With delayed therapy or, for example, the use of medicines, the use of folk remedies without the consent of the doctor, an unfavorable outcome, even death, is possible.

An acute attack of renal colic is dangerous, as it provokes:

1. Obstructive pyelonephritis is one or two-sided inflammation of paired organs, accompanied by suppuration.
2. The appearance of strictures in the walls of the ureter, which leads to a persistent narrowing of the lumen.
3. Urosepsis is a toxic lesion of the tissues of the urinary system.
4. Nephrosclerosis or kidney atrophy.

In order not to complicate the process, at the slightest sign of renal colic, you should contact a urologist or call an ambulance.

Diagnostics

To clarify the clinical picture, the patient must describe in detail to the doctor the symptoms present. In addition, it is important to clarify the place of work, diet, the likelihood of an allergic reaction. It is advisable for women and girls to remember when the last menstruation was - this will help to exclude an ectopic pregnancy.

Apply both laboratory and hardware methods.

1. Clinical diagnosis involves analysis of urine samples to detect changes in composition. For research, a portion of morning urine and daily urine is provided. In the first case, the presence of impurities is determined, in the second, the functionality of the kidneys is assessed.
2. The liquid may contain leukocytes, erythrocytes or their destroyed fragments, pus.
3. The concentration of salts increases - oxalates, calcium, cysteine, urates.
4. Check the reaction to acids and alkalis.
5. During the infectious process, pathogenic bacteria are detected.
6. Increasing creatinine.

Important! If a stone comes out, it is advisable to transfer it to laboratory assistants. The composition of the calculus influences the scheme of further therapy.

Hardware diagnostics:

1. Ultrasound - penetrating into the body, ultrasonic waves are reflected from dense areas, allowing you to see the features of the structure of the kidneys, bladder and the channel connecting them, stones.
2. Radiography - helps to identify oxalates and calcium deposits.
3. Excretory urography - the introduction of a contrast solution to determine the condition of the blood vessels, as well as the ureter. Thanks to this, it is possible to visually assess the degree of narrowing of the passage, the ability of the kidneys to maintain the required level of filtration and fluid concentration. It is used after stopping an attack, when blood circulation and urine outflow are restored.
4. CT is recommended to determine the density of stones and the degree of damage to the ureter.

The program of procedures largely depends on the alleged cause of the pathology, and can be significantly expanded. But first of all, x-rays are usually taken, since in most cases a patient with renal colic has calcium stones and oxalates. Computed tomography is not cheap, therefore it is used when other methods are insufficiently informative.

Differential Diagnosis

recommended to clarify the diagnosis. In renal colic, there are no signs characteristic only for this disease. A similar clinical picture develops in many pathologies of the gastrointestinal tract, genitourinary system. With the help of laboratory tests of the provided blood and urine samples, problems with such symptoms are ruled out.

Treatment tactics for men and women

The main task for renal colic is to relieve severe pain, normalize the withdrawal of fluid, as well as find out the cause of the ailment and conduct its therapy. At the last stage, narrow specialists are attracted.

First aid

The patient can independently try to anesthetize the exit of the stone before the arrival of the ambulance.

Algorithm of pre-medical therapy:

• With each spasm, inhale deeply, remain calm.
• Take an antispasmodic or analgesic - an adult is allowed to swallow 2 tablets of Drotaverine or Noshpa 80 mg each or 4 tablets 40 mg each. If possible, it is better to inject intramuscular solutions. The herbal preparation Urolesan in capsules, in the form of syrup or drops will help.
• In the absence of these funds, Nitroglycerin placed under the tongue is suitable.
• With left-sided colic, Baralgin, Paracetamol, Citramon, Ketanov, Revalgin are taken. If the pain manifested itself on the right, which is characteristic of appendicitis, such drugs are prohibited, since pain relief will lubricate the symptoms and make diagnosis difficult.
• If you are sure that the discomfort is caused by the advancement of the calculus, you can apply a heating pad to the painful area or take a hot bath.

Important! Thermal procedures are strictly prohibited with a clinical picture of an unknown nature to the patient, as they can lead to a deterioration in the condition.

As a rule, patients with renal colic are recommended therapy in a hospital. Vital indications include:

1. Severe complications - blood pressure below 100/70 mm. rt. st, temperature exceeding 38 ̊С.
2. Bilateral pain.
3. The presence of only one paired organ.
4. Elderly age.
5. The lack of a positive effect in the provision of first aid.

In these cases, hospitalization is necessary, as doctors will restore the function of urination, which will help to avoid irreversible changes in the structure of the kidneys and prevent a tragic outcome.

Also, patients with an unexplained nature of renal colic are sent to the hospital.

Urgent care

The arriving doctor or paramedic makes a preliminary diagnosis, on the basis of which he administers an analgesic or antispasmodic, taking into account possible contraindications. The drugs of choice include:

1. Baralgin M - incompatible with alcohol and Analgin.
2. Ketorolac is prohibited for children under 16 years of age, with asthma, acute ulcers, severe renal failure.
3. Noshpa - can not be used in renal failure and hypersensitivity. Use with caution in atherosclerosis of the coronary arteries, open-angle glaucoma, prostatic hyperplasia.

After emergency care, the patient is offered hospitalization. With consent, they are transported to the inpatient department on a stretcher.

If the stone has passed by the time the medical team arrives, the person often refuses to go to the hospital. But in the first 1–3 days, medical monitoring of the condition and quality nursing care are necessary. It is possible that more than one calculus has undergone movement and in the future an attack of renal colic will be repeated.

Medical therapy in the hospital

With renal colic, treatment is carried out in a complex manner. Prescribe medications to relieve symptoms:

When a bacterial infection joins, pus is present, antibiotics are introduced into the therapy program.

The average course is 1-3 days.

Surgery

The operation is performed if conservative methods fail to eliminate the blockage of the ureter, severe consequences of the underlying pathology have developed.

Indications:

• complicated urolithiasis;
• the size of the stones is more than 1 cm;
• no effect after therapy.

Modern methods provide sparing surgical intervention with minimal risk of injury.

1. Contact lithotripsy - the impact of compressed air, ultrasound, laser beam on salt deposits. It is accompanied by a puncture of the skin or the tube of the apparatus moves through the urethra to the ureter.
2. Remote lithotripsy - ultrasound is used to destroy stones larger than 2 cm in diameter, localized in the upper or middle part of the pelvis. It is performed without damaging the skin, but under general anesthesia for high-quality relaxation of muscle tissue. Contraindications: pregnancy, blockage of the ureter, densely packed stones, bleeding disorders.
3. Endoscopy - a flexible instrument is inserted into the ureter through the urethra to capture and remove the calculus.
4. Stenting - a metal frame is installed in the narrowed lumen, which allows you to expand the passage and prevent further renal colic.
5. Percutaneous nephrolithotomy - stones are removed through a puncture. The procedure is controlled by an x-ray machine.

Open-cavitary kidney surgery is rarely used, as it is the most traumatic. It is indicated for purulent-necrotic process, damage to the tissues of the organ, in the presence of especially large calculi.

If the surgical intervention was carried out using a sparing method, the patient can leave the inpatient department after 2-3 days.

Renal colic and acute intestinal obstruction

Often, against the background of renal colic, intestinal volvulus develops. It is accompanied by severe pain, but the person's condition is considered satisfactory.

Symptoms include nausea with no relief and repeated vomiting, which leads to the diagnosis of intestinal obstruction. With renal colic, a single attack is more often noted.

For the examination, listening to the abdominal area is used - intense noises in the intestinal region are characteristic. Urinalysis reveals hematuria.

Diet

Meat and fish are consumed only in boiled form.

Shown to exclude from the menu:

• salt;
• sweet pastries;
• fresh bread;
• broths;
• smoked meats and sausages;
• fatty cheeses;
• fried and boiled eggs;
• salinity;
• marinades;
• canned food;
• radishes, mushrooms, spinach, legumes, sorrel, radishes, onions and garlic;
• spicy seasonings;
• chocolate and coffee;
• fatty meats, liver, duck, brains, kidneys;
• fruits with coarse fiber.

After diagnosis, the diet is adjusted with the help of a nutritionist who will take into account the cause and develop an optimal nutrition program.

For example, with urolithiasis, it is shown to introduce more foods with dietary fiber into the menu that prevent the formation of stones. To do this, it is enough to use daily:

• 100 g of bread from coarse flour;
• 200 g potatoes;
• 70 g carrots;
• 30 g of beets;
• 100 g pears.

But at the same time, it is necessary to know exactly the composition of the stones. Otherwise, an incorrectly selected diet can worsen the patient's condition.

• With urate compounds, they consume more dairy products, juices, fruits and vegetables, reduce the volume of meat, fish, legumes, cereals, eggs.
• In the presence of oxalates, bread made from wholemeal flour, rye and wheat bran, millet, pearl barley, oatmeal and buckwheat, dried fruits are introduced into the diet.
• If phosphaturia is detected, the diet is diversified with bakery products, poultry, fish, meat, cereals without milk, pumpkin, honey and weak coffee or tea, compotes, confectionery sweets.

The differences in the menu are huge and you can’t do without the help of a specialist.

Effective folk methods

If it is not possible to resort to medicine, renal colic therapy is performed at home. There are several recipes to reduce pain.

1. Hot bath with the addition of sage or birch leaves, cudweed, linden flowers or chamomile. For one session, 10 g of vegetable raw materials are enough.
2. Infusion of steel roots, mint and birch leaves, juniper berries. Mix the components in equal volumes and brew 1 liter of boiling water 1 tbsp. l. collection. After half an hour, the folk remedy is filtered and drunk.
3. To soften the withdrawal of oxalates and phosphorus calculi, inflorescences of immortelle, blue cornflower and black elderberry, budra grass, burnet roots and bearberry leaves are used. A glass of boiling water pour 2 tbsp. l. funds and insist 15 minutes on a steam bath. Pass the solution through a sieve after 4 hours. In a warm form, they drink 4 times a day after meals, 50 ml.
4. A good therapeutic effect is provided against urate stones by barberry fruits in combination with juniper, harrow root and shepherd's purse. Steamed in a liter of boiling water 2 tbsp. l. mixture and continue heating for 15 minutes. After removing from the stove, stand for 4 hours in a closed container. Take 50 liters four times a day before meals.

Folk recipes will help not to get sick if you first consult with a urologist about the possibility of their use. It is necessary to take into account the characteristics of salt deposits, the risk of an allergic reaction to the ingredients, and discuss the duration of the course. Otherwise, home therapy will not bring benefits.

Forecast and prevention

If you seek medical help in a timely manner, the prognosis of renal colic is favorable. When the diagnosis and visits to the doctor are delayed, the disease becomes more complicated, which increases the likelihood of death as a result of shock, sepsis, and organ failure.

You can prevent the development of renal colic by following simple recommendations:

1. The predisposition should be the basis for regular examinations and consultations with a urologist.
2. It is necessary to consume a sufficient amount of vitamins A and D. If it is not possible to replenish their reserves with the help of natural products, special complexes are used.
3. Sunbathing helps the body produce vitamin D on its own.
4. Do not neglect moderate physical activity.
5. Food must contain calcium.
6. Drink at least 2 liters of fluid daily.
7. Metabolic problems should be corrected, diseases of the urinary system should be treated.
8. Be sure to follow the principles of dietary nutrition to reduce the likelihood of renal colic - exclude from the menu foods that contribute to the formation of stones.
9. Do not expose the body to hypothermia.
10. Avoid injury in the lumbar region.

Prevention is constantly adhered to, if necessary, changing the usual lifestyle and diet.

Questions from readers

Naturally, a person with a predisposition to renal colic is concerned about the features of the process itself and therapy. Here is information to help you get answers.

How are vomiting and renal colic related?

The reason must be sought in the placement of nerve fibers. Both the kidneys and the gastrointestinal tract receive signals from the same zone. When the progress of the stone leads to a problem with the outflow of urine, the solar plexus is simultaneously irritated. This becomes a provocateur of attacks of nausea and vomiting, flatulence, difficulty with the discharge of feces.

Why does my bladder always seem to be full?

Such a feeling with a small release of urine is explained by the structure of the nervous system. When the stone descends into the lower part of the ureter, the receptors are irritated, causing the desire to empty. The symptom is both positive and negative at the same time. In the first case, it is noted that the calculus has passed the longest segment and will soon enter the bladder. However, the connection of the organs is narrow and a stone of considerable size easily gets stuck in it.

Can something provoke the onset of renal colic?

As a rule, an attack of renal colic begins suddenly. Sometimes it is preceded by a long trip by car, train, flight. Perhaps the occurrence of a clinical picture against the background of taking herbal remedies designed to destroy salt deposits, they become provocateurs of the movement of stones. Also, the cause is a back injury, prolonged abstinence from drinking liquids, after which the patient prefers to drink abundantly.

Is it possible to confuse renal colic with some other disease?

Other pathologies have similar symptoms, for example:

• intestinal colitis;
• radiculitis;
• renal infarction;
• acute pleurisy;
• appendicitis;
• torsion of an ovarian cyst;
• ectopic pregnancy.

Therefore, self-treatment is strictly prohibited. A thorough examination is necessary to identify the cause of the pain. It helps to accurately establish the type of disease differential diagnosis.

Can a stone get into the bladder and not come out?

This situation is quite likely when it comes to stones of significant size, exceeding the diameter of the ureter, or the disease is complicated by a narrowing of the lumen, which prevents the release of the stone.

What does a physical examination of a patient show?

What is an ultrasound scan for?

Ultrasound is an affordable, inexpensive and quite informative method in the study of renal colic. Allows you to detect a stone in the ureter, its location, expansion of the renal pelvis. But with obesity and increased flatulence, anomalies of the urinary organs, an ultrasound examination often does not work. Therefore, preference is given to complex hardware diagnostics.

Why do excretory urography and what does it show?

This method for renal colic is recognized as the most informative. It takes place in 3 stages:

1. First, a picture is taken using an X-ray machine.
2. The patient is injected with a contrast solution that penetrates the urine.
3. Re-image.

Thus, a visual representation of the size of the calculus, localization in the renal pelvis or urinary canal is obtained.

There are also contraindications to the procedure. This is an allergic reaction to iodine, which is used to prepare the coloring liquid, and thyrotoxicosis is a pathology of the thyroid gland.

What is the essence of lithokinetic therapy?

This technique is based on the use of medications that facilitate the release of large-sized elements. Non-steroidal anti-inflammatory drugs are also used, which relax the muscle tissues lining the canal, as well as antispasmodics that expand the lumen.

How long can a stone pass with lithokinetic therapy?

It takes several days to withdraw. But expectant management in renal colic is interrupted if the calculus does not leave the ureter after 2-3 days. Delay is dangerous due to fibrosis of the clogged area.

What is meant by extracorporeal lithotripsy?

So in urology they call the "gold standard" for the treatment of urolithiasis. The method has been used for 30 years and consists in using a directed flow of mechanical waves that act on salt deposits and destroy them. The procedure is carried out under the control of an X-ray unit or an ultrasound machine. According to statistics, lithotripsy helps to get rid of pathology in 95% of cases.

If the painful sensations have passed, but the stone has not come out, what should be done?

Despite the disappearance of signs of renal colic, therapy is necessary. The calculus remaining in the ureter is dangerous, as it injures the walls of the passage and can move at any time. So, an attack of renal colic will resume.

In addition, blockage of the passage leads to the accumulation of urine in the kidney and to the development of hydronephrosis, damage to the parenchyma of the organ. Therefore, the stone must be removed.

At the first sign of renal colic, you need to call an ambulance. It is not worth treating yourself without knowing the exact cause of the pain, since with an erroneous “diagnosis”, complications are likely to develop that will require prolonged therapy. Therefore, the appeal to official medicine is mandatory.

Renal colic (ICD-10 code - N23) is a pronounced pain attack of an acute nature, caused by mechanical blockage of the urinary tract, which prevents the outflow of urine from the kidney itself and, as a result, disrupts the process of normal urination.

This painful condition can develop as a result of a number of urological diseases, however, in the vast majority of cases, its appearance is preceded by. Renal colic is regarded by official medicine as a serious urgent condition that requires urgent specialist intervention aimed at quickly relieving pain and further normalizing the functionality of the urinary system.

Pathogenesis

Renal colic is essentially an acute occlusion (impaired patency) of the upper urinary tract due to their external compression or internal blockage. Severe pain accompanying renal colic occurs due to spastic reflex contraction of the muscle tissue of the ureter, an increase in hydrostatic intrapelvic pressure, swelling of the parenchyma, venous stasis, stretching of the fibrous renal capsule and ischemia of the kidney, which leads to a sharp irritation of sensitive pain receptors.

There are three stages in the development of renal colic, namely:

Acute phase

The pain attack occurs suddenly, often against the background of a completely normal state of health. If this occurs during sleep, severe pain wakes the patient. In the case of wakefulness, it is possible to fix with certainty the time of onset of renal colic.

The intensity of the pain is usually constant, but may increase over time, gradually reaching its peak over a period of approximately several hours. The level of pain depends on the personal sensitivity of the person and the rate of increase in fluid pressure in the ureter and renal pelvis. With an increase in the frequency of contractions of the ureter, the element that prevents the outflow of urine can move, which most often causes a resumption or increase in pain.

DC phase

It usually comes after a few hours, when the pain reaches its limit and can last for quite a long time. This phase is characterized by the highest degree of pain for the patient, which in some cases can last up to 12 hours, but most often lasts 2-4 hours. It is during this phase that patients, as a rule, seek medical help, since it is simply impossible to endure such pain for a long time.

Decay phase

The final phase of renal colic begins after the elimination of the cause that violates the patency of the urinary tract, which can occur both with medical help and without it. During this period, there is a sharp relief of pain, and then a gradual decrease in its intensity up to a complete cessation. With self-elimination of occlusion (for example, when a stone exits), pain can disappear at any time after an outbreak of renal colic.

Classification

Conventionally, renal colic can be divided into several varieties, depending on certain external and internal factors.

By focusing the main pain

• left-sided;
• right-sided;
• bilateral.

By type of pathology

• first appeared;
• recurrent.

Due to the occurrence

• colic on the background;
• colic on the background;
• colic against the background of growth of the perirenal;
• colic on the background of renal bleeding;
• colic against the background of vascular pathologies in the perirenal space;
• colic of unspecified cause.

Causes of renal colic

The cause of renal colic is a variety of mechanical obstacles that disrupt or completely stop the outflow of urine from the ureter and renal pelvis. As mentioned earlier, in most (57.5%) cases, an attack of renal colic develops when a strangulation occurs in any part of the ureter calculus (stone) corresponding to the variety diagnosed in the patient (oxalates, urates, phosphates, etc.).

Also, sometimes clots of pus or mucus produced during, as well as necrotic torn papillae or caseous masses formed during kidney tuberculosis .

In addition, strictures of the ureter are capable of provoking renal colic, kidney dystopia or torsion or kink of the ureter, which occurs when. In turn, external compression of the urinary tract is quite often observed in renal tumors (papillary), tumors of the prostate gland (cancer or) and ureter. Also, renal colic can be caused by post-traumatic subcapsular and retroperitoneal hematomas, including hematomas that form after remote lithotripsy .

Other causes that contribute to the occurrence of renal colic are associated with congestive or inflammatory pathologies of the urinary tract. For example, such pain attacks often develop when prostatitis , hydronephrosis , urethritis , periurethritis (in case of acute segmental swelling of the mucosa) and venous phlebostasis in the small pelvis. Occasionally, renal colic accompanies acute vascular pathologies of the urinary tract and occurs when embolism or renal vein thrombosis , as well as kidney infarction . Similarly, occasionally colic in the kidneys occurs with congenital renal anomalies, such as: spongy kidney, achalasia , megacalicosis , dyskinesia etc.

Usually, an attack of renal colic is not directly related to the intensity of physical exertion, however, abundant food or drink, stressful situations, bumpy roads, heavy lifting, falling from a height, and diuretics can contribute to its development.

Symptoms of renal colic

The classic symptomatology of renal colic is severe and cramping pain, most often felt in the lumbar region or costovertebral angle. Such a painful attack is characterized by the suddenness of its onset at any time of the day and the rapidity of its growth. From the lumbar region, pain can spread to the ileum and mesogastric region, rectum, thighs and genitals, while the localization, intensity and irradiation of pain can change (for example, when a stone moves along the ureter).

During the period of renal colic, patients are in a state of constant anxiety and tossing, as they try in vain to give their body a position that will at least slightly alleviate the pain. At this time, they have an increased urge to urinate, sometimes in conditions of dysuria (non-permanent). In the absence of such excreted urine is sometimes stained with blood. In its general analysis, leached red blood cells, small stones, protein and blood clots may be present.

Often, renal colic is accompanied by dry mouth, tenesmus (cutting, burning, drawing pains in the rectal area), cramps in the urethra, white coating on the tongue, vomit . Against its background, subfebrile temperature may be noted, , moderate and . In case of very severe pain, it is possible to form state of shock (skin pallor, hypotension, cold sweat, bradycardia, syncope). If the patient has one kidney, it may subsequently develop anuria or oliguria .

Renal colic must be differentiated from other painful conditions accompanied by lumbar and / or abdominal pain, such as: acute, acute, testicular torsion, mesenteric thrombosis , epididymo-orchitis, perforated ulcer Gastrointestinal tract, torsion of the legs of the ovarian cyst, etc.

Symptoms of renal colic in women

With renal colic, pain symptoms in women most often move from the lower back to the inguinal region, to the inside of one of the thighs and to the genitals. Also, often they can complain of a feeling of sharp pain in the vagina. In this case, it is important for women to recognize the signs of renal colic in time and not confuse it with gynecological pathologies with similar pain symptoms. For example, a similar pain syndrome, accompanied by nausea, chills, a sharp decrease in blood pressure, vomiting, pallor of the skin, etc., can be observed when the uterine tubes rupture.

Symptoms of renal colic in men

The development of renal colic in the male population has some differences from that in women. The initial pain attack very quickly spreads along the ureter to the lower abdomen, and then captures the genitals. The most acute pain symptoms in men are manifested in the penis, namely in its head. Sometimes pain can be felt in the anal region and in the perineal region. Men, as a rule, often experience the urge to urinate, which is rather difficult and rather painful.

Analyzes and diagnostics

When making a diagnosis of renal colic, the doctor is guided by the collected history, the observed objective picture of the disease state and instrumental studies.

In the process of renal colic on palpation, the lumbar region should respond with pain, and symptom of Pasternatsky (pain when tapping on one of the costal arches) must be sharply positive.

After the acute attack of pain subsides and in the case of continued outflow of urine, a study is performed, which in most cases shows the presence of blood clots or fresh, protein compounds, salts, epithelial residues, and possibly sand.

In turn, it is shown urography and overview radiography the entire abdominal cavity, allowing to exclude other abdominal pathologies. On urograms and radiographs, it is possible to recognize intestinal pneumatosis , a compacted shadow in case of kidney damage, as well as a "rarefaction halo" in the region of the perirenal tissues, which develops with their edema. Intravenous urography will show a change in the contours of the renal pelvis and calyces, displacement of the kidney, possible bending of the ureter and other internal changes that will help determine the cause of renal colic (, stone in the ureter, nephrolithiasis , etc.).

Carrying out during an attack of colic chromocystoscopy will let you know about the complete absence or delay in the release of indigo carmine from the blocked ureter, and in some cases it will help to detect hemorrhage, swelling or strangulated calculus at the mouth of the ureter.

The ideal method of initial examination is considered to be ultrasound . To study the state of the urinary system, ultrasound of the kidneys, urinary tract and bladder is performed; to exclude other abdominal pathologies - ultrasound of the pelvis and abdominal cavity.

It is possible to establish the exact cause of renal colic with the help of modern tomographic studies (CT and MRI).

Treatment of renal colic

What to do with renal colic?

At the first suspicion of renal colic, you should immediately contact a specialist and call an ambulance at home. Otherwise, the patient has a very high risk of developing serious complications that can cause, kidney death and even lead to death. When trying to relieve pain on your own, it is advisable not to take any medications (diuretics, painkillers, antispasmodics, etc.) before the doctor arrives, since they can lubricate the course of the clinical picture of the disease and make it difficult to make an accurate initial diagnosis that led to renal colic.

As a rule, most adult patients with this pathology are subject to hospitalization in a urological hospital. Patients of childhood and the elderly, pregnant women, as well as people with a single kidney are hospitalized without fail. Treatment of renal colic at home (on an outpatient basis under the supervision of a doctor) in rare cases, it is permissible to carry out with a moderately severe pain syndrome and absolute certainty that small stones that can come out spontaneously have become the cause of renal colic.

Emergency care algorithm for renal colic

Without the appropriate medical education and experience in this field, it is almost impossible to accurately determine an attack of renal colic, especially if it occurs for the first time, and therefore first aid for this condition and its treatment at home should be limited to the following actions.

First aid before the ambulance arrives

After the arrival of the ambulance, the emergency medical algorithm looks like this.

First aid by an ambulance doctor

• Collection of anamnesis and information about the origin and development of the disease state.
• Making a primary diagnosis based on the data obtained and medical manipulations.
• Relief of pain with painkillers.
• Removal of spasm using antispasmodics.
• Transfer of the patient to the hospital department corresponding to the initial diagnosis.

In a hospital, the treatment of renal colic in men and the treatment of renal colic in women are basically identical, with the exception of some procedures related to the structural features of a particular reproductive system, which will be discussed below.

Renal colic, treatment in men and women in a hospital

First of all, if severe pain persists in the hospital, stronger antispasmodics, analgesics or methods of pain relief, including blockade of nerve endings and epidural anesthesia .

The doctor selects further therapy for renal colic on an individual basis, based on the patient's condition and the disease that caused it:

• When passing through the ureter of small stones, treatment is usually limited to the appointment of antispasmodic and analgesic drugs up to the complete release of the calculus;
• In case of blockage of the ureter, they initially try to remove the obstruction with medications (force the obstruction to come out on its own or dissolve), and if it fails, they use lithotripsy ;
• Treatment will require 10 to 21 days and is mainly with antibiotics;
• With an inflection of the ureter against the background of nephroptosis (omission of the kidney), at first the patient is shown wearing a special bandage and physical exercises that help strengthen the muscle frame, and in case of complications (presence of stones,) surgical intervention may be necessary.
• Ureteral stricture (narrowing of the lumen of the canal) is corrected only surgically.
• Abdominal tumors resulting in torsion or kinking of the ureter should be resected with or without resection.

The doctors

Medications

Antispasmodic remedies

To reduce the severity of spasm of the urinary tract, which will contribute to their relaxation and possibly the independent exit of a calculus or other obstacles, in a hospital, injectable antispasmodics are prescribed primarily on the basis of:

• Dolce ;
• Ple-Spa ;
• No-X-Sha .

In case of personal intolerance to this active substance or its insufficient action, its analogues are resorted to:

• etc.

Pain medications

Primary painkillers for renal colic belong to the group nonsteroidal analgesics and combined drugs that, in this pathology, are able to simultaneously solve two parallel problems. Firstly, they reduce the formation of arachidonic acid derivatives that serve as agents of pain receptors, thereby alleviating pain from stretching the walls of the kidney capsule, and secondly, they reduce glomerular filtration and reduce pressure on the fluid glomerulus.

As in the previous case, preference is given to injectable analgesics, among which are:

• etc.

For severe persistent pain, opiates are sometimes used (eg, Morphine sulfate ), however, such drugs should be used with extreme caution, since in addition to sedation and respiratory depression, they cause dependence over time.

With the relief of the patient's condition and the need to continue therapy, you can switch to antispasmodic and analgesic drugs in the form of tablets or suppositories.

Procedures and operations

In case of particularly severe pain, the attending physician in the hospital can, in order to relieve it, carry out a blockade with a solution that is injected into the round uterine ligament for women, and for men into the body of the spermatic cord. The previously used pararenal blockade for renal colic, when novocaine is injected into the perirenal tissue, is not recommended today, since it can injure an already diseased kidney, thereby making it even more difficult to work. If after the novocaine blockade pain persists at the same level, other methods of treatment, including surgery, are being considered.

In the event that the doctor failed to alleviate the patient's suffering with the help of medicines, ureteral catheterization . If, when performing this manipulation, the doctor manages to bypass the obstruction that clogged the ureter with a catheter, all previously accumulated urine is removed, which brings the patient long-awaited relief and significantly alleviates the pain symptoms of renal colic.

If it is impossible to carry out catheterization and there is no progress along the ureter of the calculus, the use of lithotripsy , which is one of the most effective ways of crushing stones. In this case, wave remote-shock lithotripsy can be used (shock waves directionally crush stones into small parts that subsequently come out on their own), percutaneous nephrolithotripsy (destruction of the calculus using an endoscope inserted through a micro-incision in the skin) and contact lithotripsy (grinding of the stone by means of ureteroscope inserted into the urethra).

If it is necessary to remove a small ureteral stricture, it can be excised using endoscopic surgery. If compression of the urinary canal occurs due to the fault of a blood vessel, it is possible to carry out a laparoscopic procedure, during which the doctor dissects the ureter, moves the necessary vessel to its back surface and stitches the incision. With a large area of ​​the affected areas and the impossibility of their excision, an operation is practiced to replace the affected areas of the ureter, using the patient's own intestinal tissues for this.

With renal colic due to twisting or bending of the ureter, which led to various tumor formations in the abdominal cavity, it is recommended to resort to surgical intervention. If the tumor is benign, its resection is performed in order to prevent cellular malignancy (acquisition by the cells of a benign tumor of the characteristic features of a malignant formation). In the case of the presence of large tumors, their complex treatment is used, including surgery and further. In inoperable cancer, chemotherapy is indicated in combination with radiotherapy.

Treatment with folk remedies

To prevent the occurrence of renal colic, traditional medicine recommends the following recipes.

apple peel

Three times a day, drink 200 ml of hot water with powder mixed in it (1 tablespoon) from dried apple peel.

radish

In the morning on an empty stomach, eat a salad of raw radish or drink a glass of freshly squeezed juice from this vegetable (you can also drink 200 ml of birch sap per day on an empty stomach).

Horsetail

Three times in 24 hours, take orally 0.5 cups of infusion of horsetail, which is prepared by steaming 20 g of chopped dry grass in 200 ml of boiling water for 30 minutes.

Fasting days

Regularly once a week arrange fasting days on fresh watermelon, apples or cucumbers.

Madder dye

Take orally "Marena dye" (sold in a pharmacy in the form of tablets) 1 pc. 3 times a day, after dissolving the tablet in 200-250 ml of warm water;

Lemon juice

To achieve the complete disappearance of small stones or sand for just a few weeks, you can drink the juice of a whole lemon 2-3 times daily mixed with 100-150 ml of hot water.

Vegetable fresh

Three to four times a day, drink 100-150 ml of freshly squeezed juices of beets, carrots and cucumbers mixed in equal parts.

rosehip roots

In order to dissolve stones to fine grains of sand, it is recommended to drink 0.5 cups of decoction from crushed rosehip roots 4 times a day, 2 tbsp. l. which should be boiled for 10 minutes in 200 ml of water, then insist until cool, wrapped in a blanket.

Rose hips and flowers

You can also fight stones with the help of an infusion of rose hips and flowers, insisting 1 tsp for two hours. of this raw material in a glass of boiling water and daily use instead of tea.

Flax seeds

Within 2 days, every 2 hours, it is advised to drink 100-150 ml of flax seed decoction, prepared by boiling 1 tsp. flaxseed in a glass of water (the resulting infusion is quite thick and therefore can be diluted with water).

knotweed grass

Three teaspoons of freshly chopped knotweed grass should be infused for 4 hours in 400 ml of boiling water, then drink 0.5 cups three times a day before meals.

nettle grass

One tablespoon (with a slide) of dried nettle herb should be infused for 30 minutes in 1 cup of boiling water and taken 3 times in 24 hours, 1 tablespoon.

burdock roots

Dry crushed burdock roots in a volume of 10 grams should be boiled for 20 minutes in 200 ml of water and drunk 1 tbsp. l. three times a day.

It should be remembered that all the traditional medicines described above do not have proven effectiveness in terms of destroying stones, and can also negatively affect other internal organs of the human body. Uncontrolled use of these prescriptions without consulting a doctor can potentially be harmful to health.

Prevention of renal colic

In order to prevent the formation of renal cocrements, which are the main cause of renal colic, official medicine recommends taking drugs such as, Uralit-U , and various related herbal preparations. The selection of such prophylactic drugs and the appropriateness of their use must be carried out by a specialist (nephrologist, urologist).

Treatment and symptoms of renal colic in men

As a rule, the symptoms of renal colic in men develop due to the infringement of a stone in the lumen of the ureter with a previous stone with different localization. This pathology can be observed at any age, however, most of the deposits of kidney stones are found in adult men in the period from 20 to 40 years, and bladder stones are most often found in boys with congenital strictures of the ureters and older men with.

The main symptom of colic in the kidneys in men, namely severe pain, initially appears on one side of the lumbar region, after which it can spread down the ureter, extending into the testicle and penis. At the same time, representatives of the stronger sex often experience particularly acute pain in the head of the penis. In addition to the painful manifestations already described above, an attack of colic in men is often accompanied by purulent, bloody and mucous secretions in the urine. Along with specific pain, such a symptom indicates the development of renal colic, since it indicates the inflammatory processes occurring in the ureter.

First aid and further treatment of renal colic in men fully complies with general recommendations, but in comparison with therapy in women, the release of the calculus usually takes longer, since the male urethra is much longer. For the same reason, it is also difficult to carry out some medical manipulations, for example, catheterization of the ureter.

Treatment and symptoms of renal colic in women

Symptoms of renal colic in women can occur at any age and mostly repeat similar manifestations in men. The main difference between the pain syndrome is that, originating in the lumbar region, it subsequently most often radiates to the inner thigh and genitals, and can also be felt in the uterus. A woman can experience similar pain sensations and other symptoms associated with renal colic (chills, nausea, hyperthermia, decreased blood pressure, etc.) with many other pathologies of the gynecological sphere, and therefore in this case it is extremely important to correctly make an initial diagnosis and confirm it in a hospital.

In addition to intra-abdominal pathologies ( perforated ulcer , attack , acute , intestinal obstruction etc.) renal colic in women can be confused with diseases such as:

• ruptured ovarian cyst or torsion of her legs;
• acute inflammation of the uterine appendages;
• tubal abortion ;
• pipe perforation ;

All these conditions pose a serious threat to the health and even the life of a woman, and therefore the first aid in their detection and further treatment should be adequate and consistent with the noted pathology.

Renal colic in children

Compared to adult patients, children experience the state of renal colic a little differently. The pain syndrome, as a rule, develops in them in the umbilical region and is accompanied by nausea and often vomiting. Body temperature remains normal or rises to subfebrile. Severe spasmodic pain usually lasts about 15-20 minutes, after which there is a short period of relative calm with a further resumption of pain. During an attack, the child behaves extremely restlessly, often cries and cannot find a place for himself.

At the first manifestations of such pain and other negative symptoms, the child's parents are advised to try to put him to bed and calm him down if possible, and then immediately call an ambulance, informing the dispatcher of the seriousness of the situation. In this case, hospitalization is mandatory, since it is urgent to find out the root cause of the pathology and start its treatment as early as possible. After stopping an acute attack, a comprehensive examination of the child should be carried out to clarify the overall picture of his health and take adequate preventive measures in the future.

Due to their condition, pregnant women are at risk of developing renal pathologies, including colic, since during the gestation of the fetus, the kidneys function in an “emergency” mode. That is why the condition of the kidneys and the rest of the urinary system during this period must be monitored especially carefully, regularly visiting a gynecologist, urologist and passing a urine test.

In this sense, the 3rd trimester of pregnancy is extremely important and at the same time dangerous, since it is during it that renal colic most often occurs, which, due to its spasmodic severe pain, is categorically contraindicated for pregnant women. This condition can provoke involuntary uterine contractions, which can cause either. In turn, a pregnant woman can confuse pain with colic with incipient contractions or pathological conditions of an acute nature.

In any case, if any severe pain is detected during pregnancy, it is best not to take the medication on your own, but to urgently call an ambulance that will take the patient to the hospital. Before the arrival of the doctor, it is strictly forbidden to do thermal procedures. The maximum allowable home treatment should be limited to taking a relatively safe antispasmodic, for example - or.

Diet for renal colic

After the treatment of renal colic, in order to prevent the recurrence of its development, doctors recommend that the patient reconsider his own diet and adhere to a certain diet that corresponds to the identified condition in terms of the presence of certain stones.

Consequences and complications

Untimely assistance with renal colic or its improper therapy can cause:

• obstructive in acute form;
• stricture of the ureter ;
• bacteremic shock (due to exposure to pathogenic bacteria);
• urosepsis (promotion of infection beyond the boundaries of the urinary system);
• decrease in renal functionality;
• kidney death .

Forecast

In the case of adequate and timely treatment of renal colic, the prognosis for the further condition of the patient is almost always favorable. Compliance with an appropriate diet after an attack can significantly reduce the possibility of recurrence of this painful condition in the future.

List of sources

• Komyakov, B. K. Urology [Text]: textbook / B. K. Komyakov. - Moscow: GEOTAR-Media, 2011. - 464 p. : ill. - Bibliography: p. 453. - Subject. decree: p. 454-462.
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• Pushkar, D. Yu. Functional urology and urodynamics [Text] / D. Yu. Pushkar, G. R. Kasyan. - Moscow: GEOTAR-Media, 2014. - 376 p. : ill. - (B-ka doctor-specialist. Urology). - Bibliography. at the end of ch. - Item decree: p. 373-376.
• Urology [Text]: wedge. rec. / Ch. ed. N. A. Lopatkin; Ros. about-in urologists. - Moscow: GEOTAR-Media, 2007. - 352 p. : tab. - Bibliography. at the end of chapters. - Item decree: p. 343-347.
• Hinman, F. Operative urology [Text]: atlas / F. Hinman; per. from English. ; ed. Yu. G. Alyaev, V. A. Grigoryan. - Moscow: GEOTAR-Media, 2007. - 1192 p. : ill. - Item decree: p. 1103-1132. - Bibliography: p. 1133-1191.