Initial Management for Renal Colic: Expel, Decompress or Shocks

Over half a million patients present to emergency departments (ED) and nearly 3 million patients visit healthcare providers annually due to problems associated with urolithiasis [1]. Initial management includes analgesia and antiemetics. Additionally, a urinalysis and creatinine are required laboratory evaluations. Acute imaging with a non-contrast CT (NCCT) scan is the diagnostic imaging modality of choice. Low-dose non-contrast CT (LD-NCCT) scans are now standard of care for the initial diagnosis of renal colic in patients with a BMI ? 30. Medical expulsive therapy (MET) is recommended for patients with a ureteral calculus <10mm and no signs of infection. Emergent urinary decompression is mandatory for a specific subset of patients, especially those with infection. Although limited data exists, emergent ureteroscopy or even shock wave lithotripsy may also be therapeutic options.