GPAtlas🧭 When to suspect
Renal or ureteric colic describes the acute, severe, colicky loin-to-groin pain caused by a stone obstructing the upper urinary tract. The pain is typically unilateral, comes in waves, and radiates from the flank to the groin, testicle or labium as the stone migrates down the ureter. A hallmark is that the patient is restless and cannot find a comfortable position – the opposite of peritonitis, where movement worsens pain and the patient lies still.
Most stones are calcium oxalate. Non-visible (microscopic) haematuria is present in around 85% of cases, but its absence does not exclude a stone. The two priorities in primary care are to confirm the diagnosis with imaging – a low-dose non-contrast CT of the kidneys, ureters and bladder (CT KUB) within 24 hours – and to exclude the dangerous mimics and emergencies, chiefly a leaking abdominal aortic aneurysm (AAA) in the older patient and an obstructing stone with infection.
Raise suspicion in those with a previous stone or family history, dehydration or hot-climate work, recurrent urinary infection, gout, hyperparathyroidism, inflammatory bowel disease, or stone-promoting drugs. Management is driven largely by stone size and site.
| Stone size | Likelihood of spontaneous passage | Typical approach |
|---|---|---|
| < 5 mm | High – around 80% pass | Conservative: analgesia, normal fluids and safety-netting; most pass spontaneously |
| 5–10 mm | Intermediate – around 50% | Analgesia; consider an alpha-blocker (medical expulsive therapy, MET) for distal ureteric stones; refer if not passing |
| > 10 mm | Low – unlikely to pass | Refer for urological intervention: shockwave lithotripsy (SWL), ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) |
|
🧠 Clinical pearl A first episode of "renal colic" in a patient over 60 should never be diagnosed on clinical grounds alone. A leaking AAA produces identical loin-to-back pain and is indistinguishable at the bedside. Arrange urgent imaging that will both find the stone and exclude an aneurysm – a missed AAA is rapidly fatal. |
Source: NICE NG118
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