Box 154 Pain treatment options urolithiasis [4851

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Treatments with Grade A or B evidence

Agents to assist stone passage [51] NSAIDs (Level I)

Calcium channel blockers (nifedipine) (Level I) a-Adrenoceptor antagonists (tamsulosin, terazocin, doxazocine) (Level II) Nitroglycerine and other nitrates (Level IV) Lithotripsy (Level I) Analgesics, antispasmodics Opioids including tramadol (Level II or III) Antimuscurinics (Level III or IV) Phosphodiesterase IV inhibitors (Level II) Surgical procedures for stone removal (Level III) Acupuncture (Level III) TENS (Level II)

Drug and dietary modification to prevent stone formation

[52, 53]. Eventually the disorder leads to kidney failure. Renal stone formation and liver cyst formation are both common co-morbidities. Therapeutic regimens have been proposed which suggest a general progression from nonpharmacologic methods to non-narcotic analgesics and minimally invasive procedures to progressively more invasive procedures and the use of opioids [54]. Procedures unique to polycystic kidney disease include surgical or percutaneous drainage of the cysts to decompress the lesions, sometimes followed by marsupialization to avoid fluid reaccumulation. In a study by Brown et al. [55], 50% of patients were pain free 12-28 months after laparoscopic marsupialization. More recently, Casale and colleagues [56] reported treating 12 patients aged 8-19 years (mean age 12.4) with laparoscopic renal denervation and nephropexy. All these patients had autosomal dominant polycystic kidney disease with chronic pain that was refractory to narcotic use. All patients were reportedly pain free following surgery with a mean follow-up period of 25.5 months.

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