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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 a common 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 evidence based review of the management of urolithiasis and will cite prospective randomised controlled trials when available. #### Summary points #### Sources and selection criteria Initial evaluation of the patient with urolithiasis should include a complete medical history and physical examination. Typical symptoms of acute renal colic are intermittent colicky 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 stone enters 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 the disease (box 1). Other important features are a …