Urolithiasis – Diagnostik und Therapie der akuten Harnleiterkolik

Marco J. Schnabel; Hans-Martin Fritsche

doi:10.1055/s-0034-1377989

Urologie Scan, Table of Contents

Urologie Scan 2014; 01(02): 127-140
DOI: 10.1055/s-0034-1377989

Fortbildung

Harnsteinleiden

Urolithiasis – Diagnostik und Therapie der akuten Harnleiterkolik

Authors

Marco J. Schnabel
Hans-Martin Fritsche

Abstract

Zusammenfassung

Die Urolithiasis ist eine Volkskrankheit, der bis zuletzt eine steigende Inzidenz in Industrieländern bescheinigt wurde. Neuesten Daten zufolge beläuft sich die Prävalenz in Deutschland auf ca. 3 %, bei einer jährlichen Neuerkrankungsrate von 0,4 %. Rezidive treten bei einem Viertel der Patienten mit meist zwei oder mehr Episoden auf. Während Nierensteine oft asymptomatisch sind, führt deren Migration in den Ureter i. d. R. zu akuten Flankenschmerzen, die häufig zu einer notfallmäßigen, ärztlichen Konsultation führen. Mit steigender Inzidenz des Harnsteinleidens wurde eine Zunahme notärztlicher Vorstellungen und stationärer Aufnahmen beobachtet. Dieser Artikel widmet sich dem diagnostischen und therapeutischen Vorgehen bei akuten Flankenschmerzen mit dem Verdacht auf einen Harnleiterstein. Hierbei wird v. a. auf das Einschätzen der Dringlichkeit einer Therapie und den zur Verfügung stehenden Therapieoptionen Wert gelegt.

Full Text

References

Literatur
1 Hesse A et al. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 2003; 44: 709-713
2 Seitz C, Fajkovic H. Epidemiological gender-specific aspects in urolithiasis. World J Urol 2013; 31: 1087-1092
3 Straub M. Epidemiologie der Urolithiasis – Aktuelles vom Arbeitskreis Harnsteine. Akademie Forum DGU-Kongress. unpublished data. p. INFAS-Studie 2013
4 Eaton SH et al. Admission rates and costs associated with emergency presentation of urolithiasis: analysis of the Nationwide Emergency Department Sample 2006–2009. J Endourol 2013; 27: 1535-1538
5 Türk C et al. The EAU Guidelines on Urolithiasis. Online im Internet: http://www.uroweb.org/guidelines/online-guidelines/ [Stand: 08.08.2013]
6 Luchs JS et al. Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results. Urology 2002; 59: 839-842
7 Alleemudder A et al. Raised white cell count in renal colic: Is there a role for antibiotics?. Urol Ann 2014; 6: 127-129
8 Knoll T. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) – Ständige Kommission Leitlinien. Leitlinien zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis. 2009 2. 13-68
9 Vallone G et al. US detection of renal and ureteral calculi in patients with suspected renal colic. Crit Ultrasound J 2013; 5 (Suppl. 01) S3
10 Onur MR et al. Role of resistive index in renal colic. Urol Res 2007; 35: 307-312
11 Jandaghi AB et al. Assessment of ureterovesical jet dynamics in obstructed ureter by urinary stone with color Doppler and duplex Doppler examinations. Urolithiasis 2013; 41: 159-163
12 Shapiro SR et al. Hydronephrosis index: a new method to track patients with hydronephrosis quantitatively. Urology 2008; 72: 536-538 ; discussion 538–539
13 Ripolles T et al. Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact. Abdom Imaging 2013; 38: 863-869
14 Kielar AZ et al. Prospective evaluation of Doppler sonography to detect the twinkling artifact versus unenhanced computed tomography for identifying urinary tract calculi. J Ultrasound Med 2012; 31: 1619-1625
15 Rud O et al. Prospective evaluation of interobserver variability of the hydronephrosis index and the renal resistive index as sonographic examination methods for the evaluation of acute hydronephrosis. BJU Int 2012; 110: E350-356
16 Opdenakker L et al. Acute obstruction of the renal collecting system: the intrarenal resistive index is a useful yet time-dependent parameter for diagnosis. Eur Radiol 1998; 8: 1429-1432
17 Doehn C et al. Outcome analysis of fornix ruptures in 162 consecutive patients. J Endourol 2010; 24: 1869-1873
18 McClain PD, Lange JN, Assimos DG. Optimizing shock wave lithotripsy: a comprehensive review. Rev Urol 2013; 15 : 49-60
19 Fritsche HM. Harnsteine darstellen: Was ist die beste Technik?. Aktuel Urol 2014; 45
20 Dustin Pooler B et al. Prospective Trial for the Detection of Urolithiasis at Ultra-low-dose (Sub-mSv) Non-contrast CT: Direct Comparison against Routine Low-dose Reference Standard. J Urol 2014; Published Online: May 21, 2014
21 Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic. Cochrane Database Syst Rev 2004; 1: CD004137
22 Basak GW, Drozd-Sokołowska J, Wiktor-Jedrzejczak W. Update on the incidence of metamizole sodium-induced blood dyscrasias in Poland. J Int Med Res 2010; 38: 1374-1380
23 Hedenmalm K, Spigset O. Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol 2002; 58: 265-274
24 Andersohn F, Konzen C, Garbe E. Systematic review: agranulocytosis induced by nonchemotherapy drugs. Ann Intern Med 2007; 146: 657-665
25 Edwards JE et al. Single dose dipyrone for acute renal colic pain. Cochrane Database Syst Rev 2002; 4: CD003867
26 Worster AS, Bhanich Supapol W. Fluids and diuretics for acute ureteric colic. Cochrane Database Syst Rev 2012; 2: CD004926
27 Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 1999; 162: 688-690 ; discussion 690–691
28 Laerum E et al. Oral diclofenac in the prophylactic treatment of recurrent renal colic. A double-blind comparison with placebo. Eur Urol 1995; 28: 108-111
29 Hollingsworth JM et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006; 368: 1171-1179
30 Seitz C et al. Medical therapy to facilitate the passage of stones: what is the evidence?. Eur Urol 2009; 56: 455-471
31 Papadopoulos G et al. Hyoscine N-butylbromide (Buscopan^®) in the treatment of acute ureteral colic: what is the evidence?. Urol Int 2014; 92: 253-257
32 Picozzi SCM et al. Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients. Urol Res 2012; 40: 581-586
33 Picozzi SCM et al. Urgent shock wave lithotripsy as first-line treatment for ureteral stones: a meta-analysis of 570 patients. Urol Res 2012; 40: 725-731
34 Zheng S et al. Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: a systematic review and meta-analysis. Scand J Urol Nephrol 2010; 44 : 425-432
35 Wagenlehner FME et al. Diagnosis and management for urosepsis. Int J Urol 2013; 20 : 963-970
36 Goldsmith ZG et al. Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int 2013; 112: E122-128
37 Engel C et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 2007; 33: 606-618
38 Cao Z et al. Acute kidney injuries induced by various irrigation pressures in rat models of mild and severe hydronephrosis. Urology 2013; 82: 1453 ; e9–16
39 Aboumarzouk OM et al. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2011; 12: CD006029