Current evaluation and management of renal and ureteral stones.

A systematic clinical approach is required for the diagnosis and management of renal and ureteral stones. The presenting symptoms, past medical history, medications, and physical examination all provide clues to the diagnosis of urinary stones. In the acute setting, noncontrast helical computerized tomography has emerged as the first line imaging test for renal colic. More traditional imaging tests are also important in the management of stone disease. After making the diagnosis of a urinary stone, the urologist should discuss the advantages and disadvantages of all treatment options with the patient. For most stone patients today, many equally effective treatment approaches can exist for the same problem. To help direct surgical management, guidelines for stone management have been devised. With technologic advances, stone treatment has improved and complications have decreased. While patient care has been significantly impacted by use of effective endourologic techniques, patients should complete imaging tests following surgery to assure a stone-free state. In addition, recurrent stone formers should complete a medical stone evaluation to identify treatable causes of their stones.