Sex-based disparities in the management of acute renal colic: A retrospective analysis of emergency department outcomes

Objective: Renal colic is a frequent cause of Emergency Department (ED) visits. While management guidelines emphasize objective findings, subjective factors such as sex may influence clinical decision-making. This study investigated sex-based disparities in the management and hospital admission rates of patients with acute urolithiasis. Methods: A retrospective analysis was conducted on 546 patients presenting to the ED with renal colic. Demographic data, pain intensity (VAS), and radiographic characteristics (stone size, location, and hydronephrosis grade) were compared between sexes. Primary outcomes included hospital admission and surgical intervention rates. Multivariate logistic regression identified independent predictors of admission while adjusting for clinical severity. Results: The cohort was 75.3% male ( n = 411) and 24.7% female ( n = 135), with a median age of 48 years. No significant differences were found between men and women regarding median pain scores (8 vs 9, p = 0.16), median stone size (4.0 mm vs 4.0 mm, p = 0.77), or median hydronephrosis grade (1 vs 1, p = 0.65). Despite these clinical similarities, men were significantly more likely to be admitted to the hospital than women (49.9% vs 37.8%, p = 0.014). Multivariate analysis confirmed that sex remained an independent predictor of admission (OR 1.64, 95% CI 1.10–2.43, p = 0.015). Surgical intervention rates were also higher in men (31.4% vs 23.7%, p = 0.09). Conclusions: Male patients with renal colic were significantly more likely to be hospitalized than female patients despite comparable pain intensity and stone severity. These findings suggest sex-based disparities in the clinical disposition of urolithiasis, warranting further investigation into the clinical, social, and systemic drivers of this disparity in emergency care.