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NephrolithiasisMANAGEMENT

GENITOURINARY AND REPRODUCTIVE PRESENTATIONS · 12 SECTIONS

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782 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Acute Kidney Injury (ATN)Acute Kidney Injury (Post-renal)Acute Kidney Injury (Pre-renal)Amniotic Fluid Embolism Balanitis Bladder Rupture Breast Abscess Cystitis Dialysis access complications Ectopic pregnancy Epididymitis Glomerulonephritis Hematuria (gross)Hydrocele Interstitial Cystitis Mastitis Mittelschmerz Nephrolithiasis Nephrotic Syndrome Flare Nutcracker Syndrome Orchitis Ovarian Cyst Rupture Ovarian hyperstimulation syndrome Ovarian torsion Paraphimosis Pelvic Congestion Syndrome Pelvic Inflammatory Disease (PID)Peritoneal dialysis peritonitis Phimosis Priapism Prostatitis Pyelonephritis Renal laceration Renal transplant complications and rejection Ruptured ovarian cyst Testicular torsion Torsion of Appendix Testis Tubo-ovarian abscess Ureteral Rupture Urethritis Urinary Retention Urinary tract infection (uncomplicated)Urolithiasis (renal colic)Vaginal bleeding (non-pregnant)Vaginitis (Bacterial)Vaginitis (Candidal)Varicocele Vulvovaginal Hematoma

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp42

Immediate priorities

›Infected obstructing stone — urologic emergency

›Fever with obstructing stone on imaging

›Emergent urology consult regardless of pain control

›Sepsis protocol activation

›Sepsis physiology triggers

›SBP < 90 mmHg

›MAP < 65 mmHg

›Lactate >= 2 mmol/l

›Altered mental status

›If septic shock from obstructed infected kidney, emergent decompression

›Ureteral stent or percutaneous nephrostomy

›Broad spectrum antibiotics within 1 hour

Monitoring and targets

›Monitoring bundle

›Continuous cardiac monitor for tachyarrhythmia

›Tachycardia from pain versus sepsis differentiation

›Hypotension detection

›Urine output monitoring

›Anuria or oliguria suggests bilateral obstruction

›Solitary or transplanted kidney at higher risk

›Serial abdominal assessment

›Peritoneal signs absent in uncomplicated renal colic

›If peritoneal signs present, consider alternative diagnosis

›Vital sign thresholds

›Temperature > 37.8 C as infected stone red flag

›Obtain blood cultures prior to antibiotics

›Urine culture and urinalysis

02History/hx70

Presentation pattern

›Classic renal colic syndrome

›Acute colicky flank pain radiating to groin

›Waxing and waning corresponding to ureteral peristalsis

›Sudden onset, often waking patient from sleep

›Pain migration with stone descent

›Lower abdominal pain as stone approaches ureterovesical junction

›Ipsilateral gonadal or urethral tip radiation

›Associated symptoms

›Nausea and vomiting from shared splanchnic innervation

›Urinary urgency and frequency with distal ureteral stones

›Dysuria mimicking cystitis with stones near bladder

Alarm features

›Red flag symptoms requiring urgent evaluation

›Fever or chills with flank pain

›Infected urolithiasis until proven otherwise

›Rigors suggesting bacteremia

›Anuria or markedly decreased urine output

›Bilateral obstruction

›Obstruction of solitary or transplanted kidney

›Pain unresponsive to IV analgesics

›Alternative diagnosis consideration

›Surgical emergency evaluation

›Hematuria absence does not exclude stones

›Up to 10% of confirmed stones have no hematuria

Risk factors and prior history

›Personal stone history

›Prior stone episodes are strongest predictor of recurrence

03Physical Exam/exam41

Vitals and general appearance

›Stability snapshot

›Temperature

›Fever > 37.8 C as infected stone marker

›High fever with rigors suggests bacteremia

›Heart rate

›Tachycardia from pain versus sepsis differentiation

›Persistent tachycardia after analgesia raises sepsis concern

›Blood pressure

›Hypotension suggests septic shock

›SBP < 90 mmHg triggers resuscitation

›General appearance

›Patient writhing unable to find comfortable position

›Distinguishes renal colic from peritonitis where patient lies still

Abdominal and urologic exam

›Abdominal exam findings

›Costovertebral angle tenderness

›Ipsilateral CVA tenderness characteristic

›Bilateral CVA tenderness raises alternative diagnosis concern

›Abdominal tenderness

›Mild ipsilateral abdominal tenderness acceptable

›Peritoneal signs absent in uncomplicated colic

›Rebound and guarding suggest alternative diagnosis

›Vascular assessment

›Palpation for pulsatile abdominal mass

›AAA exclusion in older patients

›Genitourinary exam

›Testicular exam in males

04Differential Diagnosis/ddx51

Life-threatening mimics

›Cannot-miss diagnoses

›Abdominal aortic aneurysm

›ICD-10 I71.4

›Pulsatile abdominal mass

›Older patient with vascular risk factors and hypotension

›Ectopic pregnancy

›ICD-10 O00.9

›Positive beta-hCG in reproductive-age women

›Adnexal tenderness or free fluid on ultrasound

›Urosepsis from infected obstructing stone

›ICD-10 N20.1 with A41.9 association

›Fever, hydronephrosis, sepsis physiology

›Mortality risk without emergent decompression

Common mimics

›Urinary tract pathology

›Pyelonephritis

›ICD-10 N10

›Fever, pyuria, bacteriuria without stone on imaging

›May coexist with stones

›Renal infarction

›ICD-10 N28.0

›Atrial fibrillation, age >= 70, elevated LDH >= 500 mmol/l

›Absence of hematuria or pyuria with severe flank pain

›Papillary necrosis

›Sickle cell disease, analgesic nephropathy, diabetes

›Sloughed papilla may cause colic

›Gastrointestinal causes

05Laboratory Tests/lt52

Core emergency labs

›Urinalysis

›Hematuria detection

›Sensitivity 90% for ureteral stones

›Absence does not exclude stone in up to 10% of cases

›Pyuria and bacteriuria

›Suggests concurrent infection

›Urine culture required if present

›Urine pH

›Low pH < 5.5 favors uric acid stones

›High pH > 7.0 favors struvite or calcium phosphate stones

›Basic metabolic panel

›Creatinine and GFR

›AKI assessment with obstructing stone

›Baseline for contrast and medication dosing decisions

›Solitary kidney identification

›Calcium

›Hypercalcemia screen for hyperparathyroidism

›Calcium > 2.6 mmol/l warrants further evaluation

›Potassium and bicarbonate

›Electrolyte disturbance from vomiting

›Renal tubular acidosis pattern

Infection and sepsis labs

›CBC

›Leukocytosis as infection marker

›Mild WBC elevation may occur with pain alone

›Marked leukocytosis with fever suggests infected stone

›Neutrophilia with bandemia

06Diagnostic Tests/dt87

Scoring Systems

›STONE score for ureteral stone probability

›Five clinical variables

›Sex male = 2 points

›Timing of pain onset < 6 hours = 3 points

›Origin race non-black = 3 points

›Nausea or vomiting = 1 point

›Erythrocytes on dipstick = 3 points

›Score interpretation

›Low 0 to 5 stone probability 8 to 10%

›Moderate 6 to 9 stone probability 51 to 67%

›High 10 to 13 stone probability 89%

›Clinical utility

›ACEP Level B recommendation as decision support adjunct

›STONE PLUS combines score with bedside ultrasound for improved accuracy

›CLAD score for alternative urgent diagnosis

›Identifies patients needing CT to exclude surgical emergency

›Age > 50 years

›Absence of prior stone history

›Pain absence in flanks

›Abnormal aortic diameter on ultrasound

›High CLAD score warrants CT regardless of stone probability

MRI

›MRI urinary tract

›Primary indication

›Pregnancy when ultrasound inconclusive

›Radiation avoidance in young patients

›Suspected soft tissue diagnosis not visible on CT

›Performance characteristics

›Sensitivity 82% for urolithiasis

›Lower than CT for small stones

›Superior for soft tissue characterization

›Protocol considerations

›No contrast required for stone detection

›MR urography sequences

›T2-weighted sequences identify hydronephrosis

›Limitations

›Availability constraints in acute setting

›Motion artifact risk

›Poor small stone sensitivity

›Non-contrast CT abdomen and pelvis

›First-line imaging for suspected nephrolithiasis

›Sensitivity > 95% and specificity > 98% for urolithiasis

›ICD-10 guided imaging indication N20.0 to N20.2

›ACEP Level A recommendation

›Low-dose CT protocol

›Pooled sensitivity 97% and specificity 95%

›Radiation < 3 mSv versus 8 to 10 mSv standard protocol

›Preferred in younger patients to reduce lifetime radiation exposure

›Key CT findings

›Stone size and location determines management

›Hydronephrosis grade

›Perinephric stranding as obstruction severity marker

›Tissue rim sign confirms ureteral location

›Spontaneous passage prediction by size

›Stones <= 4 mm passage rate 80 to 98%

›Stones 4 to 6 mm passage rate 59 to 80%

›Stones 6 to 8 mm passage rate 48 to 60%

›Stones > 8 mm passage rate < 40%

›Alternative diagnoses detected

›Up to one-third of CT scans reveal non-stone diagnosis

›Appendicitis, AAA, ovarian pathology identified

›When CT may be deferred

›Young patient < 35 years with typical symptoms

›Hematuria confirmed on urinalysis

›Prior confirmed stone history with identical presentation

›Pain relief with analgesics and no alarm features

Ultrasound

›Renal and bladder ultrasound

›Indications

›First-line in pregnancy

›Pediatric patients to minimize radiation

›Initial study in young patients with typical presentation

›ACR appropriateness criteria supports ultrasound first approach

›Performance characteristics

›Sensitivity 45 to 67% for stone detection

›Specificity 94 to 97%

›High sensitivity 88 to 95% for hydronephrosis detection

›Key findings

›Hydronephrosis grade I to IV

›Intraluminal stone with acoustic shadowing

›Ureteral jet assessment via Doppler

›Limitations

›Poor visualization of ureteral stones especially mid-ureter

›Operator dependent

›Bowel gas interference

›Point of care ultrasound role

›STONE PLUS study supports POCUS combined with clinical score

›Hydronephrosis detection guides triage and CT decision

›ACEP Level B recommendation for POCUS in renal colic

07Disposition/dispo59

Admission indications

›Mandatory admission criteria

›Infected obstructing stone

›Any fever with hydronephrosis

›Urosepsis or septic shock

›Emergent decompression required

›Acute kidney injury

›Rising creatinine with obstructing stone

›Obstruction of solitary or transplanted kidney

›Bilateral ureteral obstruction

›Intractable symptoms

›Pain uncontrolled despite IV analgesics

›Persistent vomiting preventing oral intake

›Large stones with high-grade obstruction

›Stone > 10 mm unlikely to pass spontaneously

›High-grade hydronephrosis with pain

ICU indications

›Critical care level

›Septic shock from urosepsis

›Vasopressor requirement

›Persistent lactate elevation despite resuscitation

›Multi-organ dysfunction

›AKI with hemodynamic instability

›Altered mental status with sepsis

Discharge criteria

›Safe discharge requirements

›Pain controlled with oral analgesics

›Tolerating oral medications and fluids

08Treatment/t129

Acute analgesia

›NSAIDs — first-line analgesia

›Ketorolac IV

›15 to 30 mg IV

›Preferred first-line agent per EAU and AUA guidelines

›Reduces ureteral smooth muscle spasm

›Avoid in AKI, GI bleeding history, allergy

›Ibuprofen PO when tolerated

›600 to 800 mg PO every 6 to 8 hours

›Transition from IV ketorolac

›Maximum 3200 mg per day

›Combination analgesia superior to monotherapy

›NSAID plus opioid superior to either alone

›ACEP Level B recommendation

›Opioid analgesia — second-line

›Morphine IV

›0.1 mg/kg IV titrated to effect

›Reassess pain at 15 to 30 minutes

›Nausea common, antiemetic co-administration

›Hydromorphone IV

›0.015 mg/kg IV for moderate to severe pain

›Titrate every 15 minutes

›Preferred in morphine-intolerant patients

›IV lidocaine as alternative

›1.5 mg/kg IV over 10 minutes

›Opioid-sparing analgesic option

›Cardiac monitoring required during infusion

Antiemetics

›Nausea and vomiting management

›Ondansetron IV

›4 mg IV over 2 to 5 minutes

›First-line antiemetic

›QT prolongation risk at high doses

›Metoclopramide IV

›10 mg IV over 15 minutes

›Alternative when ondansetron unavailable

›Extrapyramidal side effect monitoring

Medical expulsive therapy

›Tamsulosin for stone passage facilitation

›Tamsulosin 0.4 mg PO daily

›Distal ureteral stones 5 to 10 mm

›Relaxes ureteral smooth muscle via alpha-1 blockade

›Continue for duration of trial of passage up to 4 to 6 weeks

›Evidence and indications

›Benefit demonstrated for stones > 5 mm in distal ureter

›No demonstrated benefit for stones < 5 mm

›AUA guideline supports MET for distal stones > 5 mm

›Not recommended agents

›Nifedipine no longer recommended for MET

›Aggressive IV hydration does not accelerate stone passage

Urosepsis and infected stone treatment

›Antibiotic therapy for infected urolithiasis

›Empiric gram-negative coverage

›Piperacillin-tazobactam 4.5 g IV every 6 hours

›Ceftriaxone 2 g IV daily for non-severe illness

›Adjust based on local resistance patterns

›Fluoroquinolone alternative

›Ciprofloxacin 400 mg IV every 12 hours

›Only if local resistance < 10%

›Oral transition when clinically stable

›Duration of antibiotics

›7 to 14 days total depending on source control

›Extend if bacteremia documented

›De-escalate per culture and sensitivity results

›Emergent decompression

›Ureteral stent placement

›Retrograde approach under anesthesia

›Drainage while awaiting definitive stone treatment

›Percutaneous nephrostomy tube

›Antegrade drainage under ultrasound or fluoroscopic guidance

›Preferred when anatomy precludes retrograde stenting

›Interventional radiology or urology performed

Interventional stone treatment

›Ureteroscopy with laser lithotripsy

›Indications

›Stones > 10 mm

›Stone not expected to pass with MET

›Failed trial of passage

›Higher stone-free rates

›Preferred for distal ureteral stones

›Stone-free rate > 90% for ureteral stones

›Post-procedure care

›Ureteral stent typically placed

›Stent removal in 2 to 4 weeks

›Shock wave lithotripsy

›Indications

›Renal stones < 20 mm

›Proximal ureteral stones

›Lower morbidity than ureteroscopy

›Contraindications

›Pregnancy

›Coagulopathy

›Obstruction distal to stone

›Aortic aneurysm

›Stone-free rates

›Lower than ureteroscopy for ureteral stones

›Repeat sessions may be required

›Percutaneous nephrolithotomy

›Indications

›Large renal stones > 20 mm

›Staghorn calculi

›Stones not accessible by ureteroscopy

›Higher complication rate

›Bleeding risk

›Requires general anesthesia

›Prolonged recovery

Recurrence prevention pharmacotherapy

›Thiazide diuretics for hypercalciuria

›Chlorthalidone 25 mg PO daily

›First-line for recurrent calcium stones with hypercalciuria

›Reduces urinary calcium excretion

›Monitor potassium

›Hydrochlorothiazide 50 mg PO daily

›Alternative thiazide option

›AUA guideline recommendation

›Indapamide 2.5 mg PO daily

›Alternative with lower metabolic side effects

›Potassium citrate

›Indication

›Hypocitraturia

›Uric acid stones

›Cystine stones

›Distal renal tubular acidosis

›Dosing

›30 to 60 mEq PO divided twice to three times daily

›Alkalinizes urine pH target > 6.0 for uric acid

›Citrate inhibits calcium oxalate crystallization

›Allopurinol for hyperuricosuria

›Indication

›Hyperuricosuria with calcium oxalate stones and normocalciuria

›Uric acid stone formers

›Dosing

›100 to 300 mg PO daily

›Start low and titrate

›Monitor renal function and CBC

09Special Populations/sp77

Pregnancy

›Pregnancy-specific considerations

›Prevalence and presentation

›Incidence 1 in 200 to 1500 pregnancies

›Ureteroscopy and colic most common in second trimester

›Physiologic hydronephrosis of pregnancy complicates interpretation

›Imaging approach in pregnancy

›Renal ultrasound first-line

›Non-contrast MRI if ultrasound inconclusive

›CT as last resort when benefits outweigh fetal radiation risk

›ACR appropriateness criteria supports this hierarchy

›Analgesic safety in pregnancy

›Acetaminophen preferred first-line for mild to moderate pain

›NSAIDs limited to second trimester only with caution

›Avoid NSAIDs in third trimester due to premature ductus closure

›Opioids short-term use with neonatal monitoring if near term

›Antibiotic safety

›Beta-lactams safe throughout pregnancy

›Cephalexin or ceftriaxone for UTI and pyelonephritis

›Avoid fluoroquinolones and tetracyclines

›MET in pregnancy

›Tamsulosin not established as safe in pregnancy

›Avoid MET unless risk-benefit clearly favorable

›Interventional management

›Ureteral stent under local anesthesia feasible

›Stent requires more frequent exchanges due to encrustation

›Ureteroscopy can be performed safely in second trimester

›Fetal monitoring during and after procedures

Geriatric

›Older adult features

›Atypical presentation risk

›Reduced pain perception may minimize reported severity

›Confusion or functional decline as primary presentation

›Afebrile infected stones more common in immunosenescence

›Comorbidity burden

›Anticoagulation affects interventional planning

›Renal insufficiency at baseline

›Cardiovascular disease limits contrast use

›Medication considerations

›NSAID caution with reduced GFR

›Avoid NSAIDs if GFR < 30 ml/min

›Opioid dose reduction with frailty

›Fall risk with opioids and tamsulosin

›AAA mimicry highest risk in older patients

›Bedside aortic ultrasound prior to assuming stone diagnosis

›Pulsatile mass palpation mandatory

›Disposition bias toward admission

›Limited home support

›Frailty and fall risk

›Greater risk of decompensation

Pediatrics

›Pediatric differences

›Epidemiologic trends

›Increasing prevalence in children linked to obesity and diet

›Metabolic disorders proportionally more common

›JAMA Pediatrics 2015 review of current trends

›Presentation differences

›Younger children may present with vague abdominal pain

›Older children similar to adult flank colic pattern

›Nausea and vomiting prominent

›Imaging preference

›Ultrasound first to minimize radiation

›Low-dose CT if ultrasound inconclusive and clinical concern high

›MRI in selected cases to avoid radiation

›Metabolic evaluation priority

›Higher yield of underlying metabolic disorder than adults

›Cystinuria, primary hyperoxaluria, RTA evaluation

›24-hour urine collection after acute episode

›Analgesia dosing

›Ketorolac 0.5 mg/kg IV maximum 15 mg per dose

›Morphine 0.1 mg/kg IV titrated every 15 to 30 minutes

›Ondansetron 0.15 mg/kg IV maximum 4 mg

›MET in children

›Tamsulosin 0.2 to 0.4 mg PO daily off-label use

›Limited evidence in pediatric population

›Cochrane review 2017 notes limited pediatric data

›Prevention in pediatric patients

›Fluid intake targets age and weight based

›Dietary modification counseling for family

›Avoid dietary oxalate restriction unless hyperoxaluria confirmed

10Background/b80

Epidemiology

›Prevalence and incidence

›US population prevalence 8.8% of adults

›Lifetime prevalence 13% in men

›Lifetime prevalence 7% in women

›Gender gap narrowing with obesity epidemic

›Recurrence rates

›5-year recurrence rate 35 to 50% without treatment

›Recurrence rate reduced to < 15% with preventive therapy

›Strongest recurrence predictor is prior stone history

›Stone type distribution

›Calcium oxalate 70 to 80% of stones

›Calcium phosphate 5 to 10%

›Uric acid 5 to 10%

›Struvite 5 to 15%

›Cystine < 1%

›Associated conditions prevalence

›Metabolic syndrome association OR 1.77

›Hypertension OR 1.61

›Diabetes OR 1.55

›Dyslipidemia OR 1.59

Pathophysiology

›Stone formation mechanisms

›Supersaturation principle

›Urine supersaturation with stone-forming salts drives crystallization

›Supersaturation depends on urinary concentration of constituents

›Inhibitors of crystallization include citrate, magnesium, and Tamm-Horsfall protein

›Calcium oxalate stone formation

›Hypercalciuria most common metabolic abnormality

›Hyperoxaluria from dietary or enteric sources

›Hypocitraturia permits crystal growth

›Uric acid stone formation

›Low urine pH < 5.5 critical factor

›Hyperuricosuria from purine excess

›Dehydration and concentrated urine

›Struvite stone formation

›Urease-producing organisms raise urine pH

›Common organisms Proteus, Klebsiella, Pseudomonas

›Staghorn calculi development risk

›Cystine stone formation

›Autosomal recessive cystinuria

›Impaired renal tubular reabsorption of cystine

›Recurrent stone formation beginning in childhood

›Obstruction and injury mechanism

›Ureteral obstruction sequence

›Initial ureteral peristalsis increase causes colic

›Hydrostatic pressure elevation with prolonged obstruction

›GFR reduction proportional to obstruction duration

›Infection in obstructed kidney

›Impaired drainage promotes bacterial proliferation

›Bacteremia risk from mucosal disruption

›Pyonephrosis and abscess formation risk

Therapeutic Considerations

›Analgesia strategy principles

›NSAIDs mechanism superiority in renal colic

›Reduce prostaglandin-mediated ureteral spasm

›Decrease GFR transiently reducing ureteral wall tension

›EAU and AUA endorse NSAIDs as first-line agents

›Opioid role as adjunct not replacement

›Combination with NSAIDs superior to monotherapy

›ACEP Level B recommendation for combination therapy

›Aggressive IV hydration not evidence based

›Does not accelerate stone passage

›Nifedipine not recommended for MET per current guidelines

›MET evidence base

›Tamsulosin mechanism and evidence

›Alpha-1A receptor blockade in distal ureter

›Demonstrated benefit for stones 5 to 10 mm

›Cochrane review supports MET for larger distal stones

›Conservative management timeframe

›4 to 6 week trial appropriate for stones <= 10 mm

›Interval imaging to assess position and obstruction

›Stone prevention evidence

›Fluid intake most evidence-based intervention

›Goal urine output >= 2 to 2.5 L per day

›ACP and AUA guideline Class I recommendation

›Dietary calcium paradox

›Low dietary calcium increases urinary oxalate and stone risk

›Normal dietary calcium 1000 to 1200 mg per day recommended

›Calcium supplements without meals increase risk

›Pharmacotherapy reserved for dietary failure

›Stone type and 24-hour urine results guide agent selection

›AUA medical management guideline 2014 framework

11Patient Discharge Instructions/pdi50

copy discharge instructions

›Kidney stone home care instructions

›Strain all urine with a stone strainer

›Catch any passed stone for laboratory analysis

›Stone type guides future prevention

›Fluid intake goals

›Drink enough fluids to produce pale yellow or clear urine

›Aim for at least 2 to 2.5 litres of fluid per day

›Water is preferred over sugary or carbonated drinks

›Pain management at home

›Take prescribed ibuprofen or naproxen as directed with food

›Take tamsulosin as prescribed to help the stone pass

›Pain may come and go as the stone moves

›Activity

›Light activity is safe and may help stone passage

›Avoid strenuous activity if pain is severe

›Warning signs to return to ER

›Fever or chills

›Temperature above 38 C is an emergency

›May signal infected stone requiring urgent drainage

›Inability to urinate

›No urine output for 8 hours

›Suggests complete obstruction

›Worsening or uncontrolled pain

›Pain not relieved by prescribed medications

›Return immediately for IV pain management

›Persistent vomiting

›Unable to keep fluids or medications down

12References/r44

Guidelines and key sources

›Primary guidelines

›AUA Medical Management of Kidney Stones Guideline 2014

›Pearle MS et al. Journal of Urology 2014

›Framework for metabolic evaluation and prevention pharmacotherapy

›EAU Guidelines on Urolithiasis 2025

›Skolarikos A et al. European Urology 2025

›Diagnosis and interventional treatment recommendations

›ACP Guideline on Recurrent Nephrolithiasis Prevention 2014

›Qaseem A et al. Annals of Internal Medicine 2014

›Dietary and pharmacologic prevention strategies

›ACR Appropriateness Criteria Flank Pain Urolithiasis 2023

›Gupta RT et al. Journal of American College of Radiology 2023

›Imaging algorithm for acute flank pain

Key clinical studies

›Landmark evidence

›STONE score derivation and validation

›Moore CL et al. BMJ 2014

›Clinical prediction rule for ureteral stone probability

›STONE PLUS study

›Daniels B et al. Annals of Emergency Medicine 2016

›STONE score combined with POCUS improves accuracy

›Nephrolithiasis ED evaluation and management review

›Gottlieb M, Long B, Koyfman A. American Journal of Emergency Medicine 2018

›Comprehensive ED management review

›Infected urolithiasis emergency management

›Yoo MJ et al. American Journal of Emergency Medicine 2024

›Urosepsis recognition and emergent decompression

Learn More: Nephrolithiasis→

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.