Ureteral calculi are formed in the kidney but produce pain as they pass down the ureter. The pain of ureteral colic is intense and the patients may be experiencing enough pain to cause them to assume a fetal position. They may even be in mild shock with cold, moist skin. There may be marked tenderness in the costovertebral angle and/or the right, and/or left lower quadrant of the abdomen. These sites of pain vary with the physical location of the stone in the ureter, whether abdominal or pelvic. There may be hematuria, either macroscopic or occult. Abdominal and back muscle spasm may be present. Referred areas of hyperesthesia are commonly present. Since the ureteral diameter varies from 1 mm to 1 cm and the nephrolith may vary much in size, shape, and configuration, the site of ureteral impedance to passage may occur at any location within the ureter.
Relief of the pain associated with ureteral stone passage may be successfully achieved by applying shortwave diathermy to the general abdominal region. The author prefers the use of a triple drum electrode with a large terry-cloth towel drape as the dielectric. The object of the application is to achieve muscular relaxation of the muscular coat of the ureteral wall. Once achieved, this will usually allow for passage of the calculus. The discharged stone should be collected for analysis along with the discharged urine.
Most stones will pass spontaneously if ureteral spasm is relieved and fluids are forced orally. If the size of the stone exceeds the relaxed diameter of the ureter or urethra, surgical removal by cystoscopy may be necessary; reduction by lithotripsy may also be necessary.
It has been my experience that abdominal/pelvic SWD application is as effective, and commonly more so, than morphine sulfate or atropine sulfate, and without the side effects. SWD must be applied for a period of time sufficient to achieve relaxation of the abdominal region and may border on provoking reaction by the thermoregulatory center resulting in general body perspiration. So long as the patient experiences no adverse effects from this process, the treatment should be effective.
There are definitive nutritional recommendations appropriate to the management of this clinical entity, but this will be deferred to an appropriate column under that subject heading, by the appropriate expert.
References
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