Üriner Taş Hastalığı / Üreter Koliği
Özet
Acil servise sık başvuru sebeplerinden biri üreter koliği ve üriner taş hastalığıdır. Kolik tarzı şiddetli ağrıyla seyreder. Ayırıcı tanısında pek çok hastalık olmakla beraber aort diseksiyonu -anevrizması gibi hayati tehdit edici hastalıklar da düşünülmelidir. Küçük boyutlu taşlar çoğu zaman kendiliğinden düşer fakat boyut büyük olunca obstrüksiyon görülebilir. Anamnez, fizik muayene ve görüntüleme yöntemleri ile tanı konulduktan sonra yapılacak iş öncelikle ağrıyı kontrol etmek sonrasında hastane yatışı ya da acil dekompresyon ihtiyacı olup olmadığını değerlendirip tedaviyi ona göre düzenlemektir.
Ureteral colic and urinary stone disease are frequent causes of presentation to the emergency department. Clinically, they are characterized by severe, colicky pain. Although a broad differential diagnosis must be considered, life-threatening conditions such as aortic dissection and aortic aneurysm should not be overlooked. Small calculi often pass spontaneously, whereas larger stones may result in urinary tract obstruction. Diagnosis is established through a combination of patient history, physical examination, and imaging studies. Initial management should prioritize effective analgesia. Subsequently, the need for hospital admission or urgent urinary decompression should be assessed, and treatment should be tailored accordingly.
Referanslar
Scales CD Jr, Smith AC, Hanley JM, et al. Prevalence of kidney stones in the United States. Eur Urol. 2012; 62:160.
Travaglini F, Bartoletti R, Gacci M, Rizzo M. Pathophy- siology of reno-ureteral colic. Urol Int. 2004;72(Suppl1):20–23.
Shokeir AA. Renal colic: new concepts related to pathophysiology, diagnosis and treatment. Curr Opin Urol. 2002; 12:263–269.
Tanagho EA, McAninch JW. Üriner taş hastalığı. In: Kazancı G, çeviri editörü. Genel Üroloji. 14. baskı. İstanbul: Nobel Tıp Kitabevleri; 1999. s. 276–300.
Shokeir AA. Renal colic: pathophysiology and manage- ment. Eur Urol. 2001; 39:241–249.
Song Y, Hernandez N, Gee MS, et al. Can ureteral sto- nes cause pain without causing hydronephrosis? World J Urol. 2016; 34:1285–1288.
Barbosa C, Garcia A, Saavedra L, Muros M. Uri- nary analysis of nephrolithiasis markers. J Chroma- togr B. 2002;781(1–2):433–455. doi:10.1016/S1570- 0232(02)00557-3
Leslie SW, Sajjad H. Hypercalciuria. In: StatPearls [In- ternet]. Treasure Island (FL): StatPearls Publishing; 2024 Feb 12.
Pokhrel B, Leslie SW, Levine SN. Primary hyperparat- hyroidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Mar 1.
Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115(10):2598–2608. Doi:10.1172/ JCI26662
Karki N, Leslie SW. Struvite and triple phosphate renal stones. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 May 30.
Stamatelou K, Goldfarb DS. Epidemiology of kidney stones. Healthcare (Basel). 2023;11(3).
Ngo TC, Assimos DG. Uric acid nephrolithiasis: recent progress and future directions. Rev Urol. 2007; 9:17– 27.
KC M, Leslie SW. Uric acid nephrolithiasis. In: StatPe- arls [Internet]. Treasure Island (FL): StatPearls Publis- hing; 2023 Oct 15.
Moussa M, Papatsoris AG, Abou Chakra M, Moussa Y. Update on cystine stones: current and future concepts in treatment. Intractable Rare Dis Res. 2020;9(2):71- 78. doi:10.5582/irdr.2020.03006.
Giannossi L, Summa V, Aydinalp C. A review of patho- logical biomineral analysis techniques and classificati- on schemes. In: Introduction to Mineralogy Studies. Rijeka: InTechOpen; 2012.
Anderson KR, Smith RC. CT for evaluation of renal colic pain. J Endourol. 2001; 15:25–29.
Tintinalli JE. Renal kolik. In: Eroğlu SE, Özhasenekler A, çeviri editörleri. Tintinalli Acil Tıp. 9. baskı. İstan- bul: Nobel Tıp Kitabevleri; 2022. s. 598–602.
Müslümanoğlu AY, Tepeler A. Renal kolik tanı ve teda- visi. Marmara Med J. 2008; 21:187–192.
Minotti B, Treglia G, Pascale M, et al. Prevalence of mic- rohematuria in renal colic and urolithiasis: a systematic review and meta-analysis. BMC Urol. 2020;20(1):119.
Rosen P, Barkin R, Danzl DF, Hayden SR, Wolfe RE. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia: Elsevier; 2018. p. 1472– 1475.
European Association of Urology. EAU Guidelines on Urolithiasis [Internet]. Arnhem (NL): European Association of Urology; 2024. Available from: https:// uroweb.org/guidelines/urolithiasis
Skolarikos A, Geraghty R, Somani B, Tailly T, Jung H, Neisius A, et al. European Association of Urology
guidelines on the diagnosis and treatment of urolit- hiasis. Eur Urol. 2025;88(1):64–75. Doi: 10.1016/j.eu- ruro.2025.03.011
European Association of Urology. EAU Guidelines on Urolithiasis. Presented at: EAU Annual Congress; 2021; Milan. ISBN: 978-94-92671-13-4.
Sim KC. Ultrasound of acute flank pain: focus on re- nal stones and acute pyelonephritis. Ultrasonography. 2018;37(4):345–354.
Skolarikos A, Geraghty R, Somani B, et al. EAU gui- delines on the diagnosis and treatment of urolithi- asis. Eur Urol. 2025;88(1):64–75. Doi: 10.1016/j.eu- ruro.2025.03.011
Al-Waili NS. Intramuscular tenoxicam to treat acute renal colic. Br J Urol. 1996; 77:15–16.
Kominsky HD, Rose J, Lehman A, et al. Trends in acute management of renal colic pain in an academic emer- gency department. J Endourol. 2020;34(11):1195– 1202.
Tahmasebi M. Opiophobia in palliative care: conqu- ering the last hill. Arch Breast Cancer. 2022:1–3. doi:10.32768/abc.2022911-3
Sin B, Koop K, Liu M, et al. Intravenous acetaminop- hen for renal colic in the emergency department. Am J Ther. 2017;24(1): e12–e19.
Masic D, Liang E, Long C, et al. Intravenous lidocaine for acute pain: a systematic review. Pharmacotherapy. 2018;38(12):1250–1259.
Yilmaz E, Batislam E, Basar MM, et al. Comparison of three alpha-1 adrenergic blockers for distal ureteral stones. J Urol. 2005; 173:2010–2012.
Golzari EJ, Soleimanpour H, Rahmani F, Mehr NZ, Safari S. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012; 12:13.
Referanslar
Scales CD Jr, Smith AC, Hanley JM, et al. Prevalence of kidney stones in the United States. Eur Urol. 2012; 62:160.
Travaglini F, Bartoletti R, Gacci M, Rizzo M. Pathophy- siology of reno-ureteral colic. Urol Int. 2004;72(Suppl1):20–23.
Shokeir AA. Renal colic: new concepts related to pathophysiology, diagnosis and treatment. Curr Opin Urol. 2002; 12:263–269.
Tanagho EA, McAninch JW. Üriner taş hastalığı. In: Kazancı G, çeviri editörü. Genel Üroloji. 14. baskı. İstanbul: Nobel Tıp Kitabevleri; 1999. s. 276–300.
Shokeir AA. Renal colic: pathophysiology and manage- ment. Eur Urol. 2001; 39:241–249.
Song Y, Hernandez N, Gee MS, et al. Can ureteral sto- nes cause pain without causing hydronephrosis? World J Urol. 2016; 34:1285–1288.
Barbosa C, Garcia A, Saavedra L, Muros M. Uri- nary analysis of nephrolithiasis markers. J Chroma- togr B. 2002;781(1–2):433–455. doi:10.1016/S1570- 0232(02)00557-3
Leslie SW, Sajjad H. Hypercalciuria. In: StatPearls [In- ternet]. Treasure Island (FL): StatPearls Publishing; 2024 Feb 12.
Pokhrel B, Leslie SW, Levine SN. Primary hyperparat- hyroidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Mar 1.
Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115(10):2598–2608. Doi:10.1172/ JCI26662
Karki N, Leslie SW. Struvite and triple phosphate renal stones. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 May 30.
Stamatelou K, Goldfarb DS. Epidemiology of kidney stones. Healthcare (Basel). 2023;11(3).
Ngo TC, Assimos DG. Uric acid nephrolithiasis: recent progress and future directions. Rev Urol. 2007; 9:17– 27.
KC M, Leslie SW. Uric acid nephrolithiasis. In: StatPe- arls [Internet]. Treasure Island (FL): StatPearls Publis- hing; 2023 Oct 15.
Moussa M, Papatsoris AG, Abou Chakra M, Moussa Y. Update on cystine stones: current and future concepts in treatment. Intractable Rare Dis Res. 2020;9(2):71- 78. doi:10.5582/irdr.2020.03006.
Giannossi L, Summa V, Aydinalp C. A review of patho- logical biomineral analysis techniques and classificati- on schemes. In: Introduction to Mineralogy Studies. Rijeka: InTechOpen; 2012.
Anderson KR, Smith RC. CT for evaluation of renal colic pain. J Endourol. 2001; 15:25–29.
Tintinalli JE. Renal kolik. In: Eroğlu SE, Özhasenekler A, çeviri editörleri. Tintinalli Acil Tıp. 9. baskı. İstan- bul: Nobel Tıp Kitabevleri; 2022. s. 598–602.
Müslümanoğlu AY, Tepeler A. Renal kolik tanı ve teda- visi. Marmara Med J. 2008; 21:187–192.
Minotti B, Treglia G, Pascale M, et al. Prevalence of mic- rohematuria in renal colic and urolithiasis: a systematic review and meta-analysis. BMC Urol. 2020;20(1):119.
Rosen P, Barkin R, Danzl DF, Hayden SR, Wolfe RE. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia: Elsevier; 2018. p. 1472– 1475.
European Association of Urology. EAU Guidelines on Urolithiasis [Internet]. Arnhem (NL): European Association of Urology; 2024. Available from: https:// uroweb.org/guidelines/urolithiasis
Skolarikos A, Geraghty R, Somani B, Tailly T, Jung H, Neisius A, et al. European Association of Urology
guidelines on the diagnosis and treatment of urolit- hiasis. Eur Urol. 2025;88(1):64–75. Doi: 10.1016/j.eu- ruro.2025.03.011
European Association of Urology. EAU Guidelines on Urolithiasis. Presented at: EAU Annual Congress; 2021; Milan. ISBN: 978-94-92671-13-4.
Sim KC. Ultrasound of acute flank pain: focus on re- nal stones and acute pyelonephritis. Ultrasonography. 2018;37(4):345–354.
Skolarikos A, Geraghty R, Somani B, et al. EAU gui- delines on the diagnosis and treatment of urolithi- asis. Eur Urol. 2025;88(1):64–75. Doi: 10.1016/j.eu- ruro.2025.03.011
Al-Waili NS. Intramuscular tenoxicam to treat acute renal colic. Br J Urol. 1996; 77:15–16.
Kominsky HD, Rose J, Lehman A, et al. Trends in acute management of renal colic pain in an academic emer- gency department. J Endourol. 2020;34(11):1195– 1202.
Tahmasebi M. Opiophobia in palliative care: conqu- ering the last hill. Arch Breast Cancer. 2022:1–3. doi:10.32768/abc.2022911-3
Sin B, Koop K, Liu M, et al. Intravenous acetaminop- hen for renal colic in the emergency department. Am J Ther. 2017;24(1): e12–e19.
Masic D, Liang E, Long C, et al. Intravenous lidocaine for acute pain: a systematic review. Pharmacotherapy. 2018;38(12):1250–1259.
Yilmaz E, Batislam E, Basar MM, et al. Comparison of three alpha-1 adrenergic blockers for distal ureteral stones. J Urol. 2005; 173:2010–2012.
Golzari EJ, Soleimanpour H, Rahmani F, Mehr NZ, Safari S. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012; 12:13.
