Renal Colic / Ureteric Stone — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Emergency indication?
   Any infection + obstruction / AKI / uncontrolled severe pain? (Ureteric stone obstruction causes radiating flank/abdominal pain + nausea/vomiting + hematuria. Diagnosis: NCCT (CT KUB) is the gold-standard first-line (location/size/density); EAU recommends ultrasound as the initial test (pregnancy/radiation reduction). Spontaneous passage: <5 mm ~75–90%, 5–10 mm ~50%, >10 mm <25% (distal stones pass more easily).)
   • Infection + obstruction / AKI / uncontrolled pain / fever → Emergency indication → decompression
   • Uncomplicated (suitable for expectant care) → Uncomplicated · analgesia + expulsion
2. [End] Uncomplicated · analgesia + expulsion
   Uncomplicated (<10 mm, no infection/obstruction complications, controllable symptoms): analgesia is the cornerstone — NSAID first-line (EAU, superior to opioids) + antiemetics; distal 5–10 mm stones may add medical expulsive therapy (tamsulosin/silodosin); plenty of fluids, strain urine, outpatient follow-up imaging; >10 mm or not passed in 4–6 weeks → urological stone clearance (URS/ESWL/PCNL).
3. [End] Emergency indication → decompression
   Emergency indications — infection + obstruction (obstructive pyelonephritis/pyonephrosis → urosepsis), AKI (solitary kidney/bilateral obstruction), anuria, uncontrolled severe pain/vomiting, fever: urgent urology consult, emergency decompression (ureteric stent or percutaneous nephrostomy) + antimicrobials/resuscitation, with stone clearance later; solitary kidney/fever/diagnostic doubt need immediate evaluation.

Source guidelines & references

• Renal colic/urolithiasis (EAU Urolithiasis guideline; StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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