Role of Corticosteroids in the Management of Acute Renal Colic: A Quasi-Experimental Study

Abstract

Background: Acute renal colic, a prevalent urological emergency, is primarily managed with nonsteroidal anti-inflammatory drugs (NSAIDs). However, the risks associated with prolonged NSAID use necessitate alternative therapeutic strategies. Corticosteroids, by virtue of their potent anti-inflammatory properties, may mitigate ureteral edema and inflammation, thereby facilitating spontaneous stone passage and diminishing the need for analgesics.

Methodology: This quasi-experimental study was conducted at the Department of Urology, Khyber Teaching Hospital, Peshawar, from June, 2025, to December, 2025. We enrolled consecutive patients presenting with acute renal colic and ureteral stones ≤6 mm confirmed by CT-KUB. Demographic and clinical data were systematically collected. All patients received standard care, with a subset receiving adjunctive corticosteroids based on clinical judgment. The primary outcomes were the rate of spontaneous stone expulsion and the reduction in pain intensity as measured by the Visual Analogue Scale (VAS). Data were analyzed using descriptive statistics and stratified analyses by age, gender, stone size, and medication use.

Results: A total of 121 patients were included (mean age 57 ± 15 years; 53% male). A high rate of successful outcomes was observed, with 108 patients (89%) achieving spontaneous stone expulsion. A corresponding proportion (89%) experienced significant pain reduction. Notably, adjunctive steroid therapy was associated with a significant reduction in the requirement for supplemental analgesia compared to NSAID-only management. While expulsion rates did not differ significantly by age or gender, they were significantly higher for smaller stones (≤3 mm vs. 4-6 mm, p=0.03).

Conclusion: The addition of corticosteroids to standard therapy appears to be an effective strategy for managing acute renal colic. It is associated with effective pain control and may facilitate spontaneous stone expulsion, while significantly reducing the overall analgesic burden. This approach could minimize the risks associated with high-dose or prolonged NSAID use. These findings support the consideration of corticosteroids in management protocols for select patients, pending confirmation from larger randomized controlled trials.