Presentation:
Severe loin to groin pain due to a ureteric calculus.
"As painful as childbirth."
Stones <=5mm in size have a 90% chance of passing spontaneously.
Stones >=5mm require admission for lithotripsy + stenting.
Investigations:
- Bloods - inflammatory markers and renal function
- UA - presence of haematuria only 80% sensitive for a stone
- CT renal tract - typically shows stone with hydroureter and hydronephrosis
- US - less sensitive as ureters poorly visualised. Retrocystic or intrarenal stones may be seen.
Discharge criteria:
- Stone <=5mm
- Pain well controlled
- Afebrile
- Absence of pyuria
- Normal renal function
An infected stone can proceed rapidly to sepsis and urgent drainage of the infected ureter by a urologist is required.
Medications:
- Paracetamol
- Indometacin PR 100mg effect on prostaglandins reduces renal pelvis pressure
- Opiates - may require large doses of morphine / fentanyl
- Tamsulosin (if for discharge)
- Antibiotics - as per UTI if infection present
If a patient with a ureteric stone is discharged, they should have a follow-up CT renal scan to confirm stone passage in 3 weeks.
EBM:
Kianpour, P., et al. (2024). Enhancing analgesia in acute renal colic pain: a randomized controlled trial of gabapentin adjunct to ketorolac-based regimen. Frontiers in Pain Research, 5, 1427711.
Finding: Adding 600 mg of oral gabapentin significantly reduced pain intensity at 60 and 90 minutes and lowered total morphine rescue requirements.
Wang, J., et al. (2025). Exploring the Efficacy and Safety of Ketamine for Managing Acute Renal Colic. International Journal of Molecular Sciences, 26(1), 371.
Finding: A review of recent RCTs indicates that intranasal (IN) and intravenous (IV) ketamine are as effective as parenteral NSAIDs and opioids for acute pain management.