Clinical presentation of stone disease

Renal colic

The classic manifestation of ureteral stone disease is renal colic. It generally occurs when a stone migrates from the kidney into the ureter and causes acute obstruction.

Typical pain

The patient presents with pain that is:

• severe flank pain;
• generally unilateral;
• relatively sudden in onset;
• fluctuating in intensity;
• radiating to the lower abdomen, groin, or genitals depending on the location of the stone;
• accompanied by restlessness and difficulty finding a comfortable position.

It may be accompanied by:

• nausea;
• vomiting;
• sweating;
• urinary symptoms;
• hematuria.

Hematuria may be present, but its absence does not rule out stone disease.

The location of symptoms may change as the stone progresses down the ureter.

Not all flank pain is renal colic

The differential diagnosis includes:

• pyelonephritis;
• musculoskeletal conditions;
• appendicitis;
• diverticulitis;
• biliary disease;
• gynecologic conditions;
• ectopic pregnancy;
• ovarian torsion;
• abdominal aortic aneurysm;
• other abdominal or retroperitoneal causes.

That is why the medical history and physical examination remain essential.