Introduction

Learning objectives

Apply the five key questions when facing renal colic.
Recognize when it can be managed on an outpatient basis and when it requires urgent referral.
Understand why an infected urinary obstruction is a urologic emergency.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

Renal colic is usually caused by ureteral obstruction secondary to a stone.

Typical presentation

severe flank pain;
radiation to the flank, groin, or genitals;
nausea or vomiting;
restlessness;
possible hematuria.

Initial evaluation

We should immediately ask:

Does the patient have a fever? Do they have a single functioning kidney? Are they urinating? Is their renal function impaired? Can the pain be controlled?

It can initially be managed on an outpatient basis when

the patient is stable;
there is no infection;
renal function is preserved;
pain is controllable;
the patient tolerates oral intake;
follow-up is possible.

⚠️ Urgent referral

fever or sepsis associated with obstruction;
anuria;
impaired renal function;
obstruction of a solitary kidney;
refractory pain;
persistent vomiting;
certain special situations, such as pregnancy.

⚠️ Alert

Urinary obstruction + infection = urologic emergency. It may require urgent drainage with a ureteral catheter or nephrostomy. Definitive treatment of the stone is generally performed after the infection is controlled.

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PDF

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Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

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Clinical case

Content pending upload Progressive clinical case focused on decision-making.

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Renal colic