Contrast Media and Pain in Patients with Acute Ureteral Stone Obstruction

Abstract

A randomized study was conducted in 43 patients who were in pain due to acute ureteral obstruction. Emergency urography was performed in all patients, using cither a low osmolar non-ionic (iohexol) or a high osmolar ionic (metrizoate) contrast medium. Increase of pain following injection of contrast media was found in 56 percent of all patients. Increase of pain occurred with both contrast media without any difference between the degree of pain nor the number of patients who experienced an increase of pain. Delayed excretion was considered the only reliable indicator of the degree of obstruction in the present study. Nineteen (68%) of the 28 patients with a delayed excretion > 10 min experienced increased pain while the incidence of pain increase was significantly lower (33%) in patients without that sign of ureteral obstruction (p < 0.05). The increase of pain was not associated with a simultaneous increase of the mean arterial blood pressure.

Keywords

Contrast media effects comparative studies ureter obstruction iohexol metrizoate

Get full access to this article

View all access options for this article.

References

Allen

J. T.

Vaughan

E. D.

Jr Gillenwater

J. Y.

: The effect of indometacin on renal blood flow and unilateral ureteral obstruction. Invest. Urol. 15 (1978), 324.

Arvola

: Roentgen diagnosis of renal and ureteral calculus. Ann. Chir. Gynaecol. (1953) Suppl. No. 1, p. 20.

Bretland

P. M.

: Acute ureteric obstruction. A clinical and radiological study, p. 164. Butterworth & Co Ltd, London 1972.

Gottschalk

G. W.

Mulle

: Micropuncture study of pressures in proximal tubules and peritubular capillaries of the rat kidney and their relation to ureteral and renal venous pressures. Amer. J. Physiol. 185 (1956), 430.

Häggmark

Hietala

S.-O.

Reiz

Sjödin

J.-G.

Sunnegårdh

Wirell

: Central and renal haemodynamic effects of intravenous infusion of non-ionic and ionic contrast media. An experimental investigation in the pig. Acta Radiol. Diagnosis 26 (1985), 491.

Heindrich

: Intravenöse Urographie und pelvirenaler Übertritt. Zentralbl. Chir. 31 (1934), 1822.

Holder

J. C.

Dalrymple

G. V.

: Pain and aortofemoral arteriography. The importance of chemical structure and osmolality of contrast agents. Invest. Radiol. 16 (1981), 108.

Kiil

: The response of the upper urinary tract to distension and obstruction. In: The function of the ureter and renal pelvis. p. 8. Oslo University Press, Oslo 1957.

Lindgren

(Editor): Iohexol, a non-ionic contrast medium. Pharmacology and toxicology. Introduction. Acta Radiol. (1980) Suppl. No. 362, p. 9.

10.

Mitchelle

D. J.

: I.V.P. in renal colic. Brit. Med. J. 3 (1967), 243.

11.

Ohnhaus

E. E.

Adler

: Methodological problems in the measurement of pain. A comparison between the verbal rating scale and the visual analogue scale. Pain 1 (1975), 379.

12.

Risholm

: Studies on renal colic and its treatment by splanchnic block. Acta Chir. Scand. (1954) Suppl. No. 184, p. 20.

13.

Sjöberg

Almén

Golman

: Excretion of contrast media for urography. Urine volume and iodine concentration during free urine flow in rabbits. J. Beige Radiol. 62 (1975), 451.

14.

Sjöberg

Golman

Almén

: Excretion of urographic contrast media. Iohexol and sodium diatrizoate during ureteric stasis in the rabbit. Acta Radiol. (1980) Suppl. No. 362, p. 99.

15.

Tillmann

Adler

Fuchs

W. A.

: Pain in peripheral arteriography. A comparison of low osmolality contrast medium with a conventional compound. Brit. J. Radiol. 52 (1979), 102.