Urolithiasis affects 5-15% of the population worldwide. Recurrence rates are close to 50%, and the cost of urolithiasis to individuals and society is high. Acute renal colic is a common presentation in general practice, so a basic understanding of its evaluation and treatment would be useful. Most of the literature is retrospective, but we will try to provide evidence based review of the management of urolithiasis and will cite prospective randomised controlled trials when available. Initial evaluation of the patient with urolithiasis should include a complete medical history and physical examination. Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting. Lower urinary tract symptoms such as dys‑uria, urgency, and frequency may occur once a stone enters the ureter. Comorbid diseases should be identified; particularly any systemic illnesses that might increase the risk of kidney stone formation or that might influence the clinical course of the disease. Other important features are a personal or family history of kidney stones with previous treatments and stone analysis, and any anatomical abnormalities or surgery of the urinary tract.  A complete history of drugs use can help identify those that are known to increase the risk of kidney stones. Assessment should include measurement of vital signs because fever may be an indication for acute intervention.  Physical examination often reveals costovertebral angle or lower abdominal tenderness. Urinalysis should be performed in all patients. Microscopic haematuria combined with the typical symptoms of renal colic is highly predictive of urolithiasis, but stones may occur in the absence of haematuria. Positivity for nitrites or bacteria and leucocytes on urine dipstick analysis may indicate urinary tract infection, in which case urine should be sent for culture. Finally, microscopic urinalysis may identify crystals, such as the classic hexagonal crystals seen in cystinuria. In the acute setting, laboratory evaluation includes complete blood count, serum electrolytes, and measurement of renal function. A more detailed metabolic evaluation is best performed after the acute stone event has resolved. Unenhanced helical computed tomography is the best radiographic technique for diagnosing urolithiasis Shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy have replaced open surgery for treating urolithiasis. Most simple renal calculi (80-85%) can be treated with shock wave lithotripsy percutaneous nephrolithotomy is the treatment of choice for complex renal calculi Staghorn calculi should be treated, and percutaneous nephrolithotomy is the preferred treatment in most patients ureteroscopy is the preferred treatment in pregnant, morbidly obese, or patients with coagulopathy Most ureteral calculi <5 mm in diameter will pass spontaneously within four weeks of the onset of symptoms.

Regards

Calvin Parker

Editorial Assistant

Journal of Nephrology and Urology