Most patients with acute renal colic can be managed conservatively with pain medication and hydration until the stone passes. Patients can be managed at home if they are able to take oral medications and fluids.
Hospitalization is required for those who cannot tolerate oral intake or who have uncontrollable pain or fever.
•Urologic consultation
Urgent urologic consultation is warranted in patients with urinary tract infection, acute kidney injury, anuria, and/or unyielding pain, nausea, or vomiting.
•Pain control
For most patients presenting with acute renal colic, we suggest nonsteroidal antiinflammatory drugs (NSAIDs) as initial therapy for pain control, rather than opioids or other therapies (Grade 2B). We reserve opioids for patients who have contraindications to NSAIDs, have severe kidney function impairment (ie, estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2), or do not achieve adequate pain relief with NSAIDs.
•Stone passage
Patients with stones >10 mm should be referred to urology for management.
Patients with stones ≤5 mm typically do not require specific treatment; most will pass spontaneously.
For patients with stones >5 and ≤10 mm in diameter, we suggest treatment with tamsulosin for up to four weeks to facilitate stone passage (Grade 2B). If tamsulosin is not available, use of another alpha blocker (such as terazosin, doxazosin, alfuzosin, or silodosin) is reasonable. Patients are then reimaged if spontaneous passage has not definitively occurred.
Patients who fail to pass the stone after a four-week trial of conservative or medical management (eg, tamsulosin) should be referred to urology, particularly if the stone is >5 mm in diameter or there is poorly controlled pain.
•Straining urine
Patients should be instructed to strain their urine for several days and bring in any stone that passes for analysis.
•Treatment of urinary tract infection
Patients with evidence of a concurrent urinary tract infection should be promptly treated with antibiotics.
●Subsequent evaluation and management
Once the acute stone episode is over and the stone, if retrieved, is sent for analysis, the patient should be evaluated for possible underlying causes of stone disease.
