Last updated: December 2020

Urolithiasis is the formation and passage of calculi (stones) in the urinary tract.

Clinical features

– Many calculi do not cause symptoms; they may be found incidentally through radiology exams.
– Symptoms arise when calculi cause partial or complete obstruction and/or infection:
• Intermittent, acute flank to pelvic pain (renal colic). Pain can be severe and typically causes nausea and vomiting. Abdomen/flank may be tender to palpation. Patients are typically restless, finding no comfortable position.
• Haematuria and/or gravel (calculi) passed in urine.
• Fever and signs of pyelonephritis if secondary infection develops (see Acute pyelonephritis, Chapter 9).

Note: if available, ultrasound may demonstrate calculi and hydronephrosis.

Treatment

– Encourage the patient to drink fluids.
– Administer analgesics according to the intensity of pain (see Pain, Chapter 1).
– In case of secondary infection: antibiotic treatment as for pyelonephritis. The effectiveness will depend on the passage of calculi.

Note: the majority of calculi pass spontaneously. If there are signs of significant renal dysfunction or secondary infection that does not improve with antibiotic treatment, consider surgical referral.