Clinical Review
Management of renal colic
Cite this as:
BMJ
2012;345:e5499
- CME
- Pain (neurology)
- Urological surgery
- Urology
- Health education
- Health promotion
- Obesity (nutrition)
- Obesity (public health)
- Surgical diagnostic tests
- Screening (oncology)
- Surgical oncology
- Biological agents
- Degenerative joint disease
- Diet
- Drugs: musculoskeletal and joint diseases
- Epidemiologic studies
- General surgery
- Infectious diseases
- Internet
- Metabolic disorders
- Musculoskeletal syndromes
- Pain (palliative care)
- Radiology
More topics 
Fewer topics
- Matthew Bultitude, consultant urologist1,
- Jonathan Rees, general practitioner with special interest in urology2
- 1Urology Centre, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- 2Backwell and Nailsea Medical Group, Bristol, UK
- Correspondence to: M Bultitude matthew.bultitude{at}gstt.nhs.uk
Summary points
Renal colic is a common presentation (lifetime risk 12% in men, 6% in women) causing pain and morbidity
Non-contrast computed tomography is the imaging method of choice, owing to its high sensitivity and specificity
Non-steroidal anti-inflammatory drugs offer the best initial analgesia, with opiates as a second line treatment
Up to 80% of stones will pass spontaneously, and increasing evidence supports medical expulsive therapy
Patients with coexistent obstruction and sepsis should have urgent relief of the obstruction with either percutaneous nephrostomy or retrograde stent
Ureteroscopy and extracorporeal shockwave lithotripsy are highly successful treatments for ureteric stones
Urinary stone disease is increasingly prevalent, with a lifetime risk of about 12% in men and 6% in women.1 Age of onset of a first stone episode for men rises from their 20s and peaks at age 40-60 years, with an incidence of three cases per 1000 population per year. Women appear to peak a little younger in their late 20s. The male to female ratio is narrowing, with one study showing a reduction from 1.7:1 to 1.3:1 over a five year period.2 Presentation varies according to geographical and seasonal factors, with higher incidences in warmer climates and during the summer months.3
This review includes the latest information from meta-analyses, systematic reviews, randomised trials, current guidelines, and other peer reviewed evidence to provide a background on presentation, investigation, and medical and surgical management of patients with renal colic.
Sources and selection criteria
We performed a PubMed search to identify peer reviewed original articles, meta-analyses, and reviews using the search terms “renal colic” and “ureteric stone”. We also reviewed national and international guidelines, and the Cochrane Collaboration and clinical evidence databases. We considered only papers written in English, with the emphasis on more recent articles if available or if we deemed the scientific validity to be …
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