Medical & Acute Stone Management
Most ureteric stones do not need surgery — they need the right decision: is this an emergency, will it pass on its own, and what can speed its passage?
The big picture
Most ureteric stones do not need surgery — they need the right decision: is this an emergency, will it pass on its own, and what can speed its passage? The acute management of a stone is about triaging the dangerous minority (the infected, obstructed kidney) away from the majority that can be managed with analgesia, time, and sometimes a pill to help it pass.
The framework: confirm and assess (CT), rule out the emergency (infection + obstruction), decide pass-vs-intervene by size, and use medical expulsive therapy to assist passage.
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Infection + obstruction = emergency → decompress (stent/nephrostomy), don't primarily remove the stone.
Passage rates by size: ~78% (1–4 mm), 60% (5–7 mm), 39% (8–10 mm); distal passes more easily.
NSAIDs are effective first-line analgesia for renal colic (renal function permitting).
MET (tamsulosin) helps larger distal stones; benefit is limited for small (≤5 mm) stones.
Intervene for large/non-passing stones, intractable symptoms, or threatened function.