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9. Genito-urinary diseases

Urolithiasis

P artial or com plete obstruction of th e urinary tract by one or m ore calculi.

Clinical features

– Acute, som etim es intense, flank or pelv ic pain (renal colic).
– Haem aturia, m ay be accom panied by th e passag e of a calculus.
– U rinalysis: h aem aturia, leucocyturia m ay be present.
– S econd ary infections m ay d ev elop: cystitis (see pag e 224) or pyeloneph ritis (see pag e

226).

Treatment 9

– Increase fluid intake: 3 to 4 litres/d ay

– Analg esics:
• For m od erate pain:
diclofenac P O : 150 m g /d ay in 3 d iv id ed d oses for 3 d ays
+ hyoscine butylbromide P O : 30 to 60 m g /d ay in 3 d iv id ed d oses for 3 d ays
• For renal colic:
diclofenac IM : 75 m g /injection, 1 or 2 tim es/d ay for a m axim um of 2 d ays th en
ch ang e to oral treatm ent
+ hyoscine butylbromide IM : 10 to 20 m g /injection to be repeated ev ery 8 h ours
accord ing to th e clinical ev olution

– In patients with infection: antibiotic treatm ent as for pyeloneph ritis (see pag e 226).
T h e effectiv eness will d epend on th e passag e of th e calculus.

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