The treatment of pain in urology

Contemporary medicine is characterized by sophisticated specialization of the individual physician. The specialist in urological surgery may undertake one of the most important and primary medical tasks, the mitigation and therapy of pain. This review aims to provide an overview of the concepts of pain therapy in urology. Most patients benefit from basic concepts of analgesia, including measuring and documenting pain scores at the bedside by the nursing staff. Patients undergoing very painful operative procedures require more potent techniques of analgesia, e.g. intravenous patient-controlled analgesia and epidural analgesia. These techniques need adequate supervision by an acute pain service, but their implementation improves the outcome in some situations. Pain in acute renal obstruction varies in intensity and duration; hence, analgesic therapy has to be tailored to the individual patient. Pain syndromes from cancer can be more complex than those after surgery. Neuropathic pain is probably the most difficult to manage and requires consultation with a pain-management specialist. In the case of neuropathic pain, treatment only with opioids is of limited efficacy and combination with co-analgesics is necessary. In addition, invasive analgesic therapies should sometimes be considered.