On medical treatment for ureteral stone expulsion

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Holmlund, DanUmeå universitet,Kirurgi (author)

On medical treatment for ureteral stone expulsion

Article/chapterEnglish2018

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2018-02-01
Taylor & Francis,2018
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LIBRIS-ID:oai:DiVA.org:umu-146090
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-146090URI
https://doi.org/10.1080/21681805.2018.1428682DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

Notes

There is evidence that α-adrenoceptor (α-AR) antagonists facilitate the passage of ureteric stones, but the mechanism behind this effect has not been established. If one accepts that it is the friction between a ureteral stone and the mucosa that hampers the passage of the stone, and that the passage traumatizes the mucosa, the aim of treatment must be to reduce this friction. Elevated pressure above an obstructing stone results in an increase in tension in the wall of the upper urinary tract, including the tension at stone level, which causes an increase in friction and ureteric colic. Reducing pressure, by low but adequate fluid intake, non-steroidal anti-inflammatory drugs (NSAIDs), or α-AR antagonists that reduce the friction and give pain relief, seems to be rational. When the stone is pressed downwards by a high pressure the mucosa forms a bar ahead of the stone. These factors reduce the ureteral lumen and hamper the passage of both urine and the stone. The swelling can be reduced by NSAIDs. Filling of the ureter ahead of the stone reduces the friction between the stone and the ureteral mucosa. Evacuation of the urine ahead of the stone by effective peristaltic activity increases this friction. α-AR antagonists that reduce peristalsis may therefore be used to reduce the friction and consequently allow the stones to pass more often and earlier. For very early stone expulsion, a combination of NSAIDs and α-AR antagonists may be useful. There is no evidence that spasm influences the passage of ureteral stones.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
mechanism of action
medical expulsive therapy
ureteric stone
α-Adrenoceptor antagonists

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Umeå universitetKirurgi (creator_code:org_t)

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In:Scandinavian journal of urology: Taylor & Francis52:2, s. 94-1002168-18052168-1813

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Urology and Neph ...

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