Which of the following is an appropriate initial management step for a first-time kidney stone in an adult?

• A. Immediate surgical removal
• B. Pain control and hydration
• C. Delaying imaging until symptoms worsen
• D. Withholding hydration

Answer: (B)

The key idea here is that the first step in a new kidney stone episode is to provide supportive care that helps the patient pass the stone and stay comfortable. The best initial management is pain control combined with adequate hydration. Controlling the intense flank or groin pain relieves ureteral obstruction and sympathetic surge, making the patient more comfortable and easier to manage. Analgesia is usually started with NSAIDs to reduce pain and ureteral spasm, with other analgesics added if needed. At the same time, giving fluids helps maintain urine output, supports hydration, and can aid stone passage, unless there are other reasons to limit fluids.

After addressing pain and hydration, imaging and assessment guide next steps. Early imaging (often non-contrast CT, or ultrasound in specific situations) is important to determine the stone’s size and location and to check for any obstruction or signs of infection. Immediate surgical removal isn’t the initial move because many first-time stones pass with time and conservative care. Delaying imaging isn’t appropriate since treatment decisions depend on what the stone is doing. Withholding hydration would worsen dehydration and can concentrate urine, potentially worsening symptoms and delaying passage.