Urology

UTI and Renal Colic

پیشاب کی نالی کا انفیکشن / گردے کی پتھری کا درد

Flank pain radiating to the groin (renal colic, more common in renal stone) or burning micturition (more common in UTI). Both are managed the same way except that tamsulosin has no role in UTI.

ICD-10: —
Source: OPD handbook pp.61–64
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Flank pain: severe, colicky, radiating to the groin, sudden onset (more common in renal stone)
Burning micturition (more common in UTI)

Diagnosis

Send the patient for USG abdomen
If stone is less than 9 mm: add tamsulosin
If stone is 9 mm or more: send the patient for a consultant opinion

Treatment

Step 1 of 7

1. Immediate treatment: painkiller

Very severe pain of renal origin responds to a strong painkiller. Both an antispasmodic and an NSAID are given.

Inj No-Spa IV stat (necessary)
Inj Voren IM stat, or Inj Toradol IV stat
Fluids: Inj Ringer's lactate IV, as in the sample prescription

Prescription

DrotaverineAntispasmodic

DoseIV stat (necessary)

Brand Inj No-Spa

Also sold as No-Spa, Nospa, No-Spa Forte

Diclofenac sodiumNSAID

DoseIM stat

Brand Inj Voren

Also sold as Voren, Diclo, Dicloran

Ketorolac injectionNSAID injection

DoseIV stat

Brand Inj Toradol

Ringer's lactate (Hartmann's solution)IV crystalloid

DoseIV (sample prescription)

Brands Generic / hospital supply

Caution: Monitor for fluid overload, especially in dengue critical-phase recovery

Step 2 of 7

2. Discharge: antibiotic

Choose one

Prescription

CiprofloxacinFluoroquinolone antibiotic

Dose500 mg BD

Brand Mercep / Cipro / Novidat

Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin

Cefixime3rd-generation cephalosporin

Dose400 mg OD

Brand Caricef

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

MoxifloxacinFluoroquinolone antibiotic

Dose400 mg OD

Brand Mofest

Also sold as Mofest, Moxef, Avelox, Moxiget

Step 3 of 7

3. Discharge: painkillers (both antispasmodic and NSAID)

Prescription

DrotaverineAntispasmodic

DoseNo-Spa Forte 80 mg 1+1

Brand Tab No-Spa / No-Spa Forte

Also sold as No-Spa, Nospa, No-Spa Forte

PhloroglucinolAntispasmodic

Dose1+1

Brand Tab Spasrid 40 mg

NaproxenNSAID

Dose500 mg BD (1+1)

Brand Neopron / Neoprox 500 mg

Also sold as Neoprox, Neopron, Flexin, Synflex

Diclofenac sodiumNSAID

Dose50 mg BD

Brand Voren

Also sold as Voren, Diclo, Dicloran

Step 4 of 7

4. Urinary supportive

Cranberry sachet or Syp Citralka: cranberry is a natural extract for UTI; Citralka prevents acidosis

Prescription

Cranberry sachet / Citralka syrup (urinary supportive)Urinary supportive

DoseSachet: once daily in a glass of water; Syp Citralka: 2 tsf three times a day in a glass of water

Brand Cranberry sachet / Syp Citralka

Also sold as Cranberry sachet, Citralka

Step 5 of 7

5. PPI

PPI with painkillers

Prescription

EsomeprazoleProton pump inhibitor

Dose1+0 before breakfast

Brand Eswin 40 mg

Also sold as Novoteph, Esante, Eskem, Eswin, Nexum, Esso, Exium

OmeprazoleProton pump inhibitor

Dose1+1

Brand Cap Omeprazole 20 mg (sample prescription)

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

Step 6 of 7

6. Stone-size decision

Send the patient for USG abdomen
Stone under 9 mm: add Tab Tamsolin 0.4 mg once at night (bedtime) for 14 days
Stone 9 mm or more: send the patient for consultant opinion
UTI: more burning micturition; no role of tamsulosin

Prescription

TamsulosinAlpha-blocker (stone expulsion)

Dose1 at night

Brand Tab Tamsolin 0.4 mg 14 days

Not for UTI

Step 7 of 7

7. Counselling (from the Urdu notes)

Drink more water than usual
Eat more fruit and vegetables
Reduce rice, meat, lentils, spinach and similar foods (one item is illegible in the scan)
If unwell, return to the doctor

Sample prescriptions from the book (patient details removed)

Male, 35 y, pain left flank for 2 hours, severe, radiating to groin; renal colic: Inj No-Spa IV stat; Inj Toradol IV stat. Discharge: Tab Mercep 500 mg 1+1 (ciprofloxacin); Tab Spasrid 40 mg 1+1 (phloroglucinol); Tab Neopron 500 mg 1+1 (naproxen); Tab Eswin 40 mg 1+0 before breakfast (esomeprazole); cranberry sachet daily in a glass of water, or Syp Citralka 2+2+2 spoons in a glass of water. Send for USG abdomen.
Male, 26 y, right flank pain 1 hour, very severe radiating to the groin, tender right flank: Plan: Inj R/L IV; Inj No-Spa IV stat; Inj Voren IM stat. Rx for 5 days: Tab Cipro 500 mg 1+1; Tab Pytex 20 mg 1+1; Tab No-Spa Forte 80 mg 1+1; Syp Citralka 2+2+2 spoons in a glass of water; Cap Omeprazole 20 mg 1+1.