Clinical Review

Management of renal colic

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5499 (Published 29 August 2012) Cite this as: BMJ 2012;345:e5499
  1. Matthew Bultitude, consultant urologist1,
  2. Jonathan Rees, general practitioner with special interest in urology2
  1. 1Urology Centre, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
  2. 2Backwell and Nailsea Medical Group, Bristol, UK
  1. 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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