TREATMENT OF RENAL COLIC BY DESMOPRESSIN INTRANASAL SPRAY AND DICLOFENAC SODIUM

The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopres sin), is a potent antidiuretic without the presser effects of vasopres sin. A total of 18 patients with acute renal colic due to stone diseas e received 40 mu g. desmopressin intranasal spray with encouraging res ults. There was a significant decrease in the colic pain intensity fro m an initial mean visual analogue score of 67 +/- 17 mm. to 39 +/- 36 mm. within 30 minutes (p <0.001). Eight patients (44.4%) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodi um achieved complete pain relief within another 30 minutes. In other w ords, when intranasal desmopressin spray was administered before diclo fenac sodium, 94.4% of the patients achieved complete pain relief and were discharged home. The mechanism of analgesic action of desmopressi n in renal colic is uncertain. At the peripheral level, desmopressin m ay alleviate the acute renal colic through its potent antidiuretic eff ect or by relaxing the renal pelvic and ureteral smooth muscles. The c entral analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranas al desmopressin spray can be used successfully in the treatment of ren al colic. It may also replace prostaglandin synthetase inhibitors in t reating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combina tion of desmopressin with analgesics or spasmolytic drugs offers compe titive results compared with those achieved by prostaglandin synthetas e inhibitors in the treatment of renal colic.