Acute renal colic and ureterolithiasis - kidney stones (1 - 65 years) - Curbside
Acute renal colic and ureterolithiasis - kidney stones (1 - 65 years)
Editors: Dan Imler, MD
Inclusion Criteria  (Any one criteria present)
  • Clinical concern for ureterolithiasis
Exclusion Criteria
  • Complex urological surgical history (simple stents ok in adults)
  • History of complex ureterolithiasis

Consider appropriate workup (+/- CT) then urology consult if needed

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Evidence
Total Notes: 13
Evidence

1 Urinalysis & culture results

A UTI is the systemic response to a bacterial infection in the urine with pyruira representing the immune response measurable on urinalysis. Pyuria is interpreted as nitrite OR leukocyte esterase AND microscopy showing bacteria or > 10 WBC / hpf in the setting of a clinical syndrome consistent with UTI. With a UA positive for nitrate or leukacyte esterase the sensitivity is 75 percent and specificity of 82 percent. However, a negative UA should not be used to definitely rule out the diagnosis of UTI in the setting of high clinical suspicion even if both tests are negative.

In order to definitively diagnose a UTI there must be a urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following

  • Suprapubic aspiration: > 1,000 cfus
  • Catheter sample: > 50,000 cfus (often reported as 10-50,000 cfus depending on lab) 
  • Clean catch sample: > 100,000 cfus

These cultures should consist of a single predominant organism to be considered positive.



References:
  1. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.
    Roberts KB,
    Pediatrics 2011 Sep;128(3):595-610.
  2. Treatment of urinary tract infections.
    Hoberman A, Wald ER,
    Pediatr Ann 1999 Nov;28(11):688-92.
  3. Asymptomatic infections of the urinary tract. 1956.
    Kass EH,
    J. Urol. 2002 Feb;167(2 Pt 2):1016-9; discussion 1019-21.
  4. Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever.
    Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M,
    J. Pediatr. 1994 Apr;124(4):513-9.
  5. Does this woman have an acute uncomplicated urinary tract infection?
    Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S,
    JAMA;287(20):2701-10.

2 Clinical presentation

Flank or abdominal pain is the most common presenting complaint in patients with ureterolithiasis (50-75% of patients). The intensity and location of the pain is variable between patients and may often be confused for other sources. Paroxysms of pain may occur last 20 to 60 minutes, representing movement of the stone or ureteral spasm. In addition, the location of the pain may vary with the location of the stone and may change as the stone moves. Gross hematuria is a presenting symptom for nephrolithiasis in 30 to 55% of patients. Dysuria and urgency are less common complaints representing only about 10 percent of patients. Concomitant UTI may or may not be present with these complaints.



References:
  1. The natural history of asymptomatic urolithiasis.
    Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN,
    J. Urol. 1992 Feb;147(2):319-21.
  2. A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments.
    Elton TJ, Roth CS, Berquist TH, Silverstein MD,
    J Gen Intern Med 1993 Feb;8(2):57-62.
  3. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.
  4. Reexamining the value of hematuria testing in patients with acute flank pain.
    Bove P, Kaplan D, Dalrymple N, Rosenfield AT, Verga M, Anderson K, Smith RC,
    J. Urol. 1999 Sep;162(3 Pt 1):685-7.
  5. Impact of date of onset on the absence of hematuria in patients with acute renal colic.
    Kobayashi T, Nishizawa K, Mitsumori K, Ogura K,
    J. Urol. 2003 Oct;170(4 Pt 1):1093-6.
  6. Childhood urolithiasis: experiences and advances.
    Gearhart JP, Herzberg GZ, Jeffs RD,
    Pediatrics 1991 Apr;87(4):445-50.
  7. Urolithiasis in pediatric patients.
    Milliner DS, Murphy ME,
    Mayo Clin. Proc. 1993 Mar;68(3):241-8.
  8. Epidemiology of paediatric renal stone disease in the UK.
    Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, van't Hoff WG,
    Arch. Dis. Child. 2003 Nov;88(11):962-5.
  9. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome.
    VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, Trachtman H,
    J. Urol. 2007 Jun;177(6):2300-5.
  10. Pediatric stone disease: an evolving experience.
    Sternberg K, Greenfield SP, Williot P, Wan J,
    J. Urol. 2005 Oct;174(4 Pt 2):1711-4; discussion 1714.
  11. Clinical outcome of pediatric stone disease.
    Pietrow PK, Pope JC, Adams MC, Shyr Y, Brock JW,
    J. Urol. 2002 Feb;167(2 Pt 1):670-3.
  12. Recurrent abdominal pain in childhood urolithiasis.
    Polito C, La Manna A, Signoriello G, Marte A,
    Pediatrics 2009 Dec;124(6):e1088-94.
  13. Pediatric urinary stone disease--does age matter?
    Kalorin CM, Zabinski A, Okpareke I, White M, Kogan BA,
    J. Urol. 2009 May;181(5):2267-71; discussion 2271.

3 Renal Ultrasound

Evaluation of the renal pelvis without ionizing radiation is possible with renal ultrasound. However, its sensitivity (75%) is less than CT, especially for small stones (less than 5 mm), papillary or calyceal stones, or ureteral stones. Despite its lower sensitivity, in studies looking at CT, in very few cases would a CT have changed management decisions. Although not definitive an AHRQ funded NEJM 2014 multicenter, pragmatic, comparative effectiveness trial concluded that "Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations."



References:
  1. Pediatric primary urolithiasis: 12-year experience at a Midwestern Children's Hospital.
    Penido MG, Srivastava T, Alon US,
    J. Urol. 2013 Apr;189(4):1493-7.
  2. The role of the plain radiograph and renal tract ultrasound in the management of children with renal tract calculi.
    Smith SL, Somers JM, Broderick N, Halliday K,
    Clin Radiol 2000 Sep;55(9):708-10.
  3. Ultrasound and the diagnosis of renal and ureteral calculi.
    Diament MJ, Malekzadeh M,
    J. Pediatr. 1986 Dec;109(6):980-3.
  4. Ultrasound versus computerized tomography for evaluating urolithiasis.
    Passerotti C, Chow JS, Silva A, Schoettler CL, Rosoklija I, Perez-Rossello J, Cendron M, Cilento BG, Lee RS, Nelson CP, Estrada CR, Bauer SB, Borer JG, Diamond DA, Retik AB, Nguyen HT,
    J. Urol. 2009 Oct;182(4 Suppl):1829-34.
  5. The evaluation of suspected renal colic: ultrasound scan versus excretory urography.
    Sinclair D, Wilson S, Toi A, Greenspan L,
    Ann Emerg Med 1989 May;18(5):556-9.


  6. Ultrasonography versus computed tomography for suspected nephrolithiasis.
    Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR,
    N. Engl. J. Med. 2014 Sep;371(12):1100-10.
  7. Study of Tomography Of Nephrolithiasis Evaluation (STONE): methodology, approach and rationale.
    Valencia V, Moghadassi M, Kriesel DR, Cummings S, Smith-Bindman R,
    Contemp Clin Trials 2014 May;38(1):92-101.

4 Risk factors

There are many risk factors for the development of ureterolithiasis. The most common include: previous history, family history and individuals with enhanced enteric oxalate absorption.



References:
  1. Randomized controlled trial of a low animal protein, high fiber diet in the prevention of recurrent calcium oxalate kidney stones.
    Hiatt RA, Ettinger B, Caan B, Quesenberry CP, Duncan D, Citron JT,
    Am. J. Epidemiol. 1996 Jul;144(1):25-33.
  2. A prospective study of nonmedical prophylaxis after a first kidney stone.
    Kocvara R, Plasgura P, Petrk A, Louzensk G, Bartonckov K, Dvorcek J,
    BJU Int. 1999 Sep;84(4):393-8.
  3. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria.
    Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, Novarini A,
    N. Engl. J. Med. 2002 Jan;346(2):77-84.
  4. The first kidney stone.
    Uribarri J, Oh MS, Carroll HJ,
    Ann. Intern. Med. 1989 Dec;111(12):1006-9.
  5. Family history and risk of kidney stones.
    Curhan GC, Willett WC, Rimm EB, Stampfer MJ,
    J. Am. Soc. Nephrol. 1997 Oct;8(10):1568-73.
  6. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.
    Asplin JR, Coe FL,
    J. Urol. 2007 Feb;177(2):565-9.
  7. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass.
    Nelson WK, Houghton SG, Milliner DS, Lieske JC, Sarr MG,
    Surg Obes Relat Dis;1(5):481-5.
  8. Crystalluria and urinary tract abnormalities associated with indinavir.
    Kopp JB, Miller KD, Mican JA, Feuerstein IM, Vaughan E, Baker C, Pannell LK, Falloon J,
    Ann. Intern. Med. 1997 Jul;127(2):119-25.


  9. Triamterene nephrolithiasis: renewed attention is warranted.
    Carr MC, Prien EL, Babayan RK,
    J. Urol. 1990 Dec;144(6):1339-40.
  10. Nephrolithiasis associated with ceftriaxone therapy: a prospective study in 51 children.
    Avci Z, Koktener A, Uras N, Catal F, Karadag A, Tekin O, Degirmencioglu H, Baskin E,
    Arch. Dis. Child. 2004 Nov;89(11):1069-72.
  11. Epidemiology of paediatric renal stone disease in the UK.
    Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, van't Hoff WG,
    Arch. Dis. Child. 2003 Nov;88(11):962-5.

5 Inital pain control

Opioid medications have been show to work well in treating renal colic. Although NSAIDs have some advantages to opioids, their use should wait until renal function is know as renal disease may not be elucidated until lab results are available. Therefore, initial treatment with opioids is a reasonable approach.



References:
  1. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.
  2. Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic.
    Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR,
    Ann Emerg Med 1996 Aug;28(2):151-8.
  3. Indomethacin suppositories versus intravenously titrated morphine for the treatment of ureteral colic.
    Cordell WH, Larson TA, Lingeman JE, Nelson DR, Woods JR, Burns LB, Klee LW,
    Ann Emerg Med 1994 Feb;23(2):262-9.
  4. A comparative study on the analgesic effects of indomethacin and hydromorphinechloride-atropine in acute, ureteral-stone pain.
    Udn P, Rentzhog L, Berger T,
    Acta Chir Scand 1983;149(5):497-9.
  5. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic.
    Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D'Onofrio G,
    Ann Emerg Med 2006 Aug;48(2):173-81, 181.e1.

6 NSAIDs pain control

Several studies have shown that NSAIDs are as efficacious for renal colic as opioids. They decrease ureteral smooth muscle tone therefore impact the urethral spasm associated with ureterolithiasis. The use of both opioids and NSAIDs in one study was superior to either alone.

NSAIDs are not indicated in patients with renal disease or other contraindications.



References:
  1. The action of the prostaglandins on isolated human ureteric smooth muscle.
    Cole RS, Fry CH, Shuttleworth KE,
    Br J Urol 1988 Jan;61(1):19-26.
  2. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.
  3. Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic.
    Cordell WH, Wright SW, Wolfson AB, Timerding BL, Maneatis TJ, Lewis RH, Bynum L, Nelson DR,
    Ann Emerg Med 1996 Aug;28(2):151-8.
  4. Indomethacin suppositories versus intravenously titrated morphine for the treatment of ureteral colic.
    Cordell WH, Larson TA, Lingeman JE, Nelson DR, Woods JR, Burns LB, Klee LW,
    Ann Emerg Med 1994 Feb;23(2):262-9.
  5. A comparative study on the analgesic effects of indomethacin and hydromorphinechloride-atropine in acute, ureteral-stone pain.
    Udn P, Rentzhog L, Berger T,
    Acta Chir Scand 1983;149(5):497-9.
  6. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic.
    Holdgate A, Pollock T,
    BMJ 2004 Jun;328(7453):1401.
  7. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic.
    Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D'Onofrio G,
    Ann Emerg Med 2006 Aug;48(2):173-81, 181.e1.

7 Laboratory workup

  • Hematuria (gross or microscopic) is present in most patients with ureterolithiasis. However, hematuria is not detected in 10 to 30% of patients with documented ureterolithiasis.
  • Urinary tract infection may complicate ureterolithiasis and should be evaluated
  • Renal function should be evaluated in patients with concern for ureterolithiasis as it may be compromised in patients with complex disease and will allow for safe administration of NSAIDs if normal
  • Pregnancy would complicate ureterolithiasis and should be evaluated in relevant females.


References:
  1. A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments.
    Elton TJ, Roth CS, Berquist TH, Silverstein MD,
    J Gen Intern Med 1993 Feb;8(2):57-62.
  2. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.
  3. Reexamining the value of hematuria testing in patients with acute flank pain.
    Bove P, Kaplan D, Dalrymple N, Rosenfield AT, Verga M, Anderson K, Smith RC,
    J. Urol. 1999 Sep;162(3 Pt 1):685-7.
  4. Incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain.
    Press SM, Smith AD,
    Urology 1995 May;45(5):753-7.
  5. Impact of date of onset on the absence of hematuria in patients with acute renal colic.
    Kobayashi T, Nishizawa K, Mitsumori K, Ogura K,
    J. Urol. 2003 Oct;170(4 Pt 1):1093-6.

8 IV hydration

Increasing urination may facilitate stone passage therefore many experts recommend IV fluids during initial evaluation. However, forced versus minimal intravenous hydration does not appear to improve stone passage or pain control.



References:
  1. Forced versus minimal intravenous hydration in the management of acute renal colic: a randomized trial.
    Springhart WP, Marguet CG, Sur RL, Norris RD, Delvecchio FC, Young MD, Sprague P, Gerardo CA, Albala DM, Preminger GM,
    J. Endourol. 2006 Oct;20(10):713-6.
  2. The pathogenesis and treatment of kidney stones.
    Coe FL, Parks JH, Asplin JR,
    N. Engl. J. Med. 1992 Oct;327(16):1141-52.
  3. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.

9 Renal CT

CT represents a sensitive modality to evaluate patients for ureterolithiasis. It may find specific clinical situations missed by ultrasound or KUB:

  • Ureteral stones
  • Radiolucent stones (uric acid stones)
  • Small (< 2 mm) stones

In addition, CT may identify other diagnoses which were not suspected initially by the provider. However, CT does utilize ionizing radiation which should be taken into account with patient populations.



References:
  1. Ultrasonography versus computed tomography for suspected nephrolithiasis.
    Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR,
    N. Engl. J. Med. 2014 Sep;371(12):1100-10.
  2. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment.
    Fulgham PF, Assimos DG, Pearle MS, Preminger GM,
    J. Urol. 2013 Apr;189(4):1203-13.
  3. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial.
    Pfister SA, Deckart A, Laschke S, Dellas S, Otto U, Buitrago C, Roth J, Wiesner W, Bongartz G, Gasser TC,
    Eur Radiol 2003 Nov;13(11):2513-20.
  4. Diagnosis of acute flank pain: value of unenhanced helical CT.
    Smith RC, Verga M, McCarthy S, Rosenfield AT,
    AJR Am J Roentgenol 1996 Jan;166(1):97-101.
  5. Benefits of CT urography in patients presenting to the emergency department with suspected ureteric colic.
    Ulahannan D, Blakeley CJ, Jeyadevan N, Hashemi K,
    Emerg Med J 2008 Sep;25(9):569-71.
  6. The value of unenhanced helical computerized tomography in the management of acute flank pain.
    Dalrymple NC, Verga M, Anderson KR, Bove P, Covey AM, Rosenfield AT, Smith RC,
    J. Urol. 1998 Mar;159(3):735-40.
  7. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison.
    Sheafor DH, Hertzberg BS, Freed KS, Carroll BA, Keogan MT, Paulson EK, DeLong DM, Nelson RC,
    Radiology 2000 Dec;217(3):792-7.
  8. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography.
    Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC,
    Radiology 1995 Mar;194(3):789-94.
  9. Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT.
    Varanelli MJ, Coll DM, Levine JA, Rosenfield AT, Smith RC,
    AJR Am J Roentgenol 2001 Aug;177(2):325-30.
  10. Pediatric urolithiasis: clinical predictors in the emergency department.
    Persaud AC, Stevenson MD, McMahon DR, Christopher NC,
    Pediatrics 2009 Sep;124(3):888-94.
  11. Urolithiasis in a children's hospital: 1985-1990.
    Nimkin K, Lebowitz RL, Share JC, Teele RL,
    Urol Radiol 1992;14(3):139-43.
  12. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography.
    Palmer JS, Donaher ER, O'Riordan MA, Dell KM,
    J. Urol. 2005 Oct;174(4 Pt 1):1413-6.
  13. CT urograms in pediatric patients with ureteral calculi: do adult criteria work?
    Smergel E, Greenberg SB, Crisci KL, Salwen JK,
    Pediatr Radiol 2001 Oct;31(10):720-3.

10 Protease inhibitors

Ureterolithiasis due to HIV protease inhibitors are not radiopaque and therefore, may not be visualized on non-contrast CT. In these cases a contrast CT should be used.



References:
  1. Crystalluria and urinary tract abnormalities associated with indinavir.
    Kopp JB, Miller KD, Mican JA, Feuerstein IM, Vaughan E, Baker C, Pannell LK, Falloon J,
    Ann. Intern. Med. 1997 Jul;127(2):119-25.
  2. Imaging characteristics of indinavir calculi.
    Schwartz BF, Schenkman N, Armenakas NA, Stoller ML,
    J. Urol. 1999 Apr;161(4):1085-7.

11 Abdominal plain films

Although plain films can identify renal stones, they have poor sensitivity and are generally not the first imaging modality of choice. They may have more utility if repeat studies are required.



References:
  1. A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments.
    Elton TJ, Roth CS, Berquist TH, Silverstein MD,
    J Gen Intern Med 1993 Feb;8(2):57-62.
  2. Urolithiasis in a children's hospital: 1985-1990.
    Nimkin K, Lebowitz RL, Share JC, Teele RL,
    Urol Radiol 1992;14(3):139-43.

12 Alpha blockers

Most stones < 5 mm will pass spontaneously, even in pediatric patients. Although continuing to controversial (and the subject of conflicting studies), many providers recommend the use of alpha blockers for medical expulsive therapy if the stone is less or equal to 10 mm. 



References:
  1. Medical therapy to facilitate urinary stone passage: a meta-analysis.
    Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, Hollenbeck BK,
    Lancet 2006 Sep;368(9542):1171-9.
  2. Efficacy of alpha-blockers for the treatment of ureteral stones.
    Parsons JK, Hergan LA, Sakamoto K, Lakin C,
    J. Urol. 2007 Mar;177(3):983-7; discussion 987.
  3. Alpha-blockers as medical expulsive therapy for ureteral stones.
    Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT,
    Cochrane Database Syst Rev 2014;4:CD008509.


  4. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi.
    Dellabella M, Milanese G, Muzzonigro G,
    J. Urol. 2005 Jul;174(1):167-72.
  5. Nifedipine versus tamsulosin for the management of lower ureteral stones.
    Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM,
    J. Urol. 2004 Aug;172(2):568-71.
  6. Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial.
    Vicentini FC, Mazzucchi E, Brito AH, Chedid Neto EA, Danilovic A, Srougi M,
    Urology 2011 Nov;78(5):1016-21.
  7. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones.
    Agrawal M, Gupta M, Gupta A, Agrawal A, Sarkari A, Lavania P,
    Urology 2009 Apr;73(4):706-9.
  8. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones.
    Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H,
    J. Urol. 2005 Jun;173(6):2010-2.
  9. Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial.
    Jayant K, Agrawal R, Agrawal S,
    Int. J. Urol. 2014 Oct;21(10):1012-5.
  10. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study).
    Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM,
    Urology 2015 Jan;85(1):59-63.
  11. 2007 guideline for the management of ureteral calculi.
    Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Trk C, Wolf JS, Wolf JS,
    J. Urol. 2007 Dec;178(6):2418-34.
  12. Clinical outcome of pediatric stone disease.
    Pietrow PK, Pope JC, Adams MC, Shyr Y, Brock JW,
    J. Urol. 2002 Feb;167(2 Pt 1):670-3.
  13. Pediatric urinary stone disease--does age matter?
    Kalorin CM, Zabinski A, Okpareke I, White M, Kogan BA,
    J. Urol. 2009 May;181(5):2267-71; discussion 2271.
  14. Effectiveness of doxazosin in treatment of distal ureteral stones in children.
    Aydogdu O, Burgu B, Gucuk A, Suer E, Soygur T,
    J. Urol. 2009 Dec;182(6):2880-4.
  15. Efficacy of medical expulsive treatment with doxazosin in pediatric patients.
    Erturhan S, Bayrak O, Sarica K, Seckiner I, Baturu M, Sen H,
    Urology 2013 Mar;81(3):640-3.
  16. Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study.
    Mokhless I, Zahran AR, Youssif M, Fahmy A,
    J Pediatr Urol 2012 Oct;8(5):544-8.
  17. Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study.
    Tasian GE, Cost NG, Granberg CF, Pulido JE, Rivera M, Schwen Z, Schulte M, Fox JA,
    J. Urol. 2014 Aug;192(2):506-11.

13 Urolithiasis vs. Nephrolithiasis

The definition of terms related to urinary tract calculi is often confusing to providers. Nephrolithiasis refers to the entire clinical picture from the formation to passage of calculi or stones in the urinary tract. Urolithiasis, however, refers specifically to the calcifications which form in the urinary system as a whole (primary in the kidney - nephrolithiasis; or ureter - ureterolithiasis) and may also form in or migrate to the lower urinary system (bladder or urethra).



References:
  1. The natural history of asymptomatic urolithiasis.
    Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN,
    J. Urol. 1992 Feb;147(2):319-21.
  2. Clinical practice. Acute renal colic from ureteral calculus.
    Teichman JM,
    N. Engl. J. Med. 2004 Feb;350(7):684-93.
  3. Urolithiasis in pediatric patients.
    Milliner DS, Murphy ME,
    Mayo Clin. Proc. 1993 Mar;68(3):241-8.