Obstructive Uropathy

Obstruction of the urinary tract causes severe pain in the flank. Chronic conditions cause a constant dull ache, in contrast to the spasmodic episodic pain with acute obstruction. Surgery may be indicated. As a general rule, pain from the upper third of the ureter is referred to the loin, pain from the middle third is referred to the iliac fossa, and pain from the lower third is referred to the suprapubic and groin area. The pain caused by ureteric calculi is often felt in the upper inner aspect of the thigh and the ipsilateral testicle in males and the labia majora in females. NSAIDs are helpful in relieving pain, an effect believed to be due to the antiprostaglandin action of NSAIDs. Calcium channel blockers (verapamil, diltiazem, and nifedipine) have been effective in treating ureteric colic. Although it is believed by some that morphine and meperidine may have a spasmogenic effect on the ureter, opiates remain the mainstay of treatment of ureteric colic.