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Pathophysiology
Acute Unilateral Ureteral Obstruction (UUO)
Release of prostaglandins, especially E2,
1. vasodilation afferent arterioles
increase (RBF) & (GFR)
more urine is produced,
renal pelvis and ureter dilate
pain
2. contraction of ureteral smooth muscle pain
3. nociceptors to stimuli (bradykinins)
pain
visceral responses (nausea, vomiting)
194 subjects
97 cases
97 controls
~ age and gender.
control
ophthalmology
outpatient
refraction
symptoms
SF-36
Female
Male
Black
White
Black
White
Prescribed
total
173,8
(198,8)
(204,1)
188,8
daily
37,3
173,8 mg
(204,1 mg)
(46,4)
(40,2)
Treatment
< 0,05
< 0,05
37,6
(207,2)
157,3
< 0,05
Dipyrone (Novalgin)
Tramadol (Tramal),
Butylscopolamine (Buscopan),
Th/ :
= 85 ps
= 93 ps
n
n
n
n
n
n
81%
74%
opioid (pethidine) ~ acute second-line therapy
Follow-up (75%) NSIDs
n
n
Resut s :
74 trials 20 trials with : 1613 participants
NSAIDs and Opioids ~ reductions pain scores
NSAIDs : - in six trials greater reduction in pain scores
- significantly less require rescue analgesia
(relative risk 0.75, 95% confidence interval 0.61 to 0.93).
less vomiting
W. PATRICK SPRINGHART, M.D.,1 CHARLES G. MARGUET, M.D.,1 ROGER L. SUR, M.D.,1 REGINA D. NORRIS, M.D.,1
FERNANDO C. DELVECCHIO, M.D.,1 MATTHEW D. YOUNG, M.D.,1 PAULA SPRAGUE, M.D.,2 CHARLES A. GERARDO, M.D.,2
DAVID M. ALBALA, M.D.,1and GLENN M. PREMINGER, M.D.1
37 rectal
47 iv
17%
43%
49%
21%
Basmah Safdar, MD, Linda C. Degutis, DrPH, Keala Landry, MD, Swarupa R. Vedere, MD, Harry C. Moscovitz, MD, Gail D Onofrio, MD
n
n
Methods :
Conservative
Herbal Supplement,
Is it necessary?
Dissolution Agent
n Alkalinizes
urine
n Depends on stone size, type, volume of
irrigant
n Oral alkalinizing agents : sodium or
potassium bicarbonate and potassium
citrate.
n Dietary modification orange juice
Tanagho Emil, McAninch Jack. Urinary Stone Disease. Smiths General Urology.
17th Edition. 2008. Mc.Graw Hill,USA
n = 70/grup
phloroglucinol
Tamsulosin
Nifedipin
Waktu keluar
120 jam
72 jam
120 jam
Ukuran : mm
6.2
7.2
6.2
Keluar
45/70
68/70
54/70
100
97.1
90
80
77.1
70
60
50
64.3
40
30
20
10
0
phloroglucinol
tamsulosin
nifedipin
Compared :
patients receiving conservative th/ only
Patients receiving conservative th/ + alfa-blockers
were 44% more likely to spontaneously expel the stones
Without or With ESWL
n
n
n
n
n
Trials (pasien)
16 (1.235)
13 (Tamsulosin)
3 (Terazosin &Doxazosin)
9 (686)
14 hari
28 hari
Advers effects
4%
15,2%
discontinuation
1 pasien (0.2%)
10 pasien (2,9%)
Follow-up Pasien
n BNO
IVP