The prevalence of ureteral stones in the US is approaching 12%, with slightly higher rates in men than women. Symptoms can include flank pain, nausea, vomiting, and urinary complaints such as hematuria, dysuria, and frequency. If stones are present in the setting of a UTI, patients can present with fevers and chills and, if not treated early, progress to hemodynamic compromise. Stable, comfortable patients with small stones (< 1 cm) should be offered outpatient expulsive therapy with oral alpha-blockers, pain medications, and a urinary strainer. Follow-up should be scheduled within 4 to 6 wk of discharge from the emergency department. A patient being managed as an outpatient should be taught about warning signs that indicate the need for immediate follow-up, such as fever, uncontrolled pain, or inability to drink or eat. Ideally, the stone should be analyzed to help guide recommendations for stone prevention; stones are collected for analysis by instructing patients to strain their urine during medical expulsive therapy or, if surgery is required, by the urologist. In patients with risk factors or multiple episodes of nephrolithiasis, the urologic work-up should be more detailed to help provide specific recommendations. Drinking 8 to 10 glasses of water per day is generally recommended to help reduce formation of all stone types.
See Urinary Calculi for more details in The Manuals.
References:
Medical management of kidney stones: AUA guideline
Management of ureteral calculi: EUA/AUA Nephrolithiasis Panel
Turk C, Petrik A, Sarica K, et al: EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69(4):e76-77, 2016. doi: 10.1016/j.eururo.2015.11.009. Epub 2015 Nov 21.
Loftus C, Nyame Y, Hinck B, et al: Medical expulsive therapy is underused for the management of renal colic in the emergency setting. J Urol 195(4 Pt 1):987-991, 2016. doi: 10.1016/j.juro.2015.11.026. Epub 2015 Nov 17.