[Medical management of acute renal colic - there is more than hydration and Buscopan®...]

Renal colic is generated by hyperperistalsis of the obstructed ureter. Peristalsis is modulated by (among others) alpha-receptors (contraction), beta-receptors (relaxation) and prostaglandins (PG F2alpha: contraction, PG E1/E2: relaxation). Non-steroidal anti-inflammatory drugs (NSAID) are highly effective in pain relief and should always be given in the absence of contraindications. The same is true for metamizole, whereas Buscopan® is not superior to placebo. For most severe pain, opioids are indicated. alpha-blockers and calcium channel blockers dilate the distal ureter and increase the likelihood of spontaneous stone passage by up to 65%. Overhydration of patients has no advantage, but carries the risk of pelvic rupture with urine extravasation and infection. Stones of/above diameter 7 mm are unlikely to pass spontaneously and should be interventionally removed.