Urolitiasis

CliniCal Review

For the full versions of these articles see bmj.com

Management of kidney stones
Nicole L Miller, James E Lingeman
Methodist Hospital Institute for Kidney Stone Disease,Indiana University School of Medicine, and International Kidney Stone Institute, Indianapolis, IN 46202, USA correspondence to: J e lingeman jlingeman@clarian.org
BMJ 2007:334:468-72 doi:10.1136/bmj.39113.480185.80

Urolithiasis affects 5-15% of the population worldwide.1 w1 Recurrence rates are close to 50%,2 w2 and the cost of urolithiasis to individuals and society is high. Acute renal colic is acommon presentation in general practice, so a basic understanding of its evaluation and treatment would be useful. Most of the literature is retrospective, but we will try to provide an evidencebased review of the management of urolithiasis and will cite prospective randomised controlled trials when available.
Sources and selection criteria We performed a literature search to identifyinformation on the management of urolithiasis. We searched databases including Medline and the Cochrane Library to assemble appropriate evidence based reference material what is the clinical presentation andinitial evaluation? Initial evaluation of the patient with urolithiasis should include a complete medical history and physical examination. Typical symptoms of acute renal colic are intermittentcolicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting.3 Lower urinary tract symptoms such as dysuria, urgency, and frequency may occur once a stoneenters the ureter. Comorbid diseases should be identified, particularly any systemic illnesses that might increase the risk of kidney stone formation or that might influence the clinical course of thedisease (box 1). Other important features are a personal or family history of kidney stones with previous treatments and stone analysis, and any anatomical abnormalities or surgery of the urinary...