=====Ureteric Colic=====
  *most originate in the kidneys
  *75% are Ca++ stones. Others include Struvite (magnesium ammonium phosphate and //associated with chronic UTI's//), uric acid and cystine.
  *Mg and citrate are important inhibitors of stone formation
  *distal stones can cause pain in testicles or labia
  
  *Ix should include dipstick test, U&E's with other tests depending on complications of setting including fever
  *degree of haematuria does not correlate with stone size or likelihood of passing
  *non-contrast CT in adults and non-pregnant women or USS for others

==Spontaneous stone passage varies according to size and location:==
  *≤2mm - average time to expulsion of 8/7
  *2–4mm - average time to expulsion of 12/7
  *4–6 mm - average time to expulsion of 22/7
  *Spontaneous passage rate has been reported as a function of stone location with
    *48% for stones in the proximal ureter
    *60% for mid ureteral stones
    *75% for distal stones
    *79% for ureterovesical junction stones

===Management===
  *NSAIDs unless contra-indicated and should not be delayed for imaging
  *opioids are 2nd choice
  *α1 blockers eg Tamsulosin (400mcg daily) for 10/7 to facilitate passage of stone (relaxation of ureter and lower urinary tract)
    *Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.
  *may need IV hydration and anti-emetic if significant vomiting
  *discharge from ED with stone clinic review if:
    *no evidence of sepsis
    *renal function not acutely impaired
    *stone is unilateral and contralateral kidney appears normal
    *pain well controlled
    *if stone >10mm definitive intervention within 4/52. Stones >7mm are less likely to spontaneously pass

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**References include:**\\ 
[[https://www.baus.org.uk/_userfiles/pages/files/Publications/Acute%20ureteric%20colic%202018.pdf|Brit Assoc Urol: Mx of ureteric colic 2017]]\\ 
[[https://emedicine.medscape.com/article/437096-overview| Nephrolithiasis overview 2020]]\\ 
[[https://www.karger.com/Article/FullText/317196|Update in Renal stone Mx]]\\ 
[[https://uroweb.org/guideline/urolithiasis/#4|Euro Soc Urology - Eval or renal stones 2020]]\\ 
[[https://www.karger.com/Article/Fulltext/510136|Likelihood of spontaneous stone passage. Systematic review: Urol Int 2021]]\\ 
[[https://www.ajronline.org/doi/pdfplus/10.2214/ajr.178.1.1780101|Stone passage and location. A Radiology J. 2001]]\\