Acute Renal Colic

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Abstract
Although generally comprehensive, Teichman's review of acute renal colic due to ureteral calculus (Feb. 12 issue)1 failed to mention the calcium-channel blocker nifedipine in the medical treatment of patients with ureteral colic. Three randomized, controlled trials have demonstrated the favorable effects of a combination of nifedipine, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAIDs) on several clinically meaningful end points, including spontaneous stone expulsion, time to stone passage, and requirements for pain medication. These studies showed up to twofold improvements in rates of spontaneous stone passage and greater than 50 percent reductions in the time required to achieve this outcome.2-4 Since one study found that nifedipine had an effect beyond that of corticosteroids,4 we have used only nifedipine plus NSAIDs, omitting the corticosteroid to minimize adverse pharmacologic effects. In general, sustained-release nifedipine is well tolerated and appears most efficacious in patients with distal ureteral stones for whom urgent surgical intervention is unnecessary.2-4