The mainstay of emergency department treatment is pain control. Because in most cases the diagnosis is clinical, a rapid urine dipstick test for heme may provide sufficient information, coupled with clinical findings, to initiate analgesic therapy. Pain medication should not be delayed pending test results. Adequate analgesia frequently requires multiple doses of intravenous narcotics, titrated to the patient's level of discomfort. Narcotics may be accompanied by nonsteroidal anti-inflammatory drugs (NSAIDs) but NSAIDs should not be used in place of narcotics. The time of onset of NSAIDs is slower than that of intravenous narcotics. NSAIDs should be used with caution in patients with suspected compromise in overall renal function (elderly patients, diabetics, those with known renal insufficiency, and hypovolemic patients) so as not to precipitate or accelerate a decline in renal function. An antiemetic is an appropriate adjunct when emesis accompanies the symptoms or when nausea accompanies narcotic use. Intravenous fluids, usually normal saline solution, should be administered. For patients with evidence of associated infection, parenteral antibiotics should be administered promptly in the emergency department, and emergency urologic consultation should be obtained.

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