Background: The aim of this study was to investigate the positive predictive value of CT scan findings and clinical signs in choice of clinical management of renal colic patients referred to the emergency department of Imam Hospital in Sari in 2020-2021. Method: A cross-sectional study was performed on all patients with renal colic who were admitted to the emergency department in Sari Imam Khomeini Hospital, in 2021. 167 patients with acute renal colic in terms of clinical manifestations, laboratory findings, and CT scan findings were evaluated.Results: In the present study, 55 patients (32.9%) underwent TUL treatment and 112 patients (67.1%) had spontaneous excretion. 48.9% of people with clinical symptoms of abdominal pain and 27% of people without symptoms of abdominal pain finally underwent TUL treatment (p = 0.008). The incidence of TUL in patients with stone size> 5 mm was significantly higher than those with stones ≤5 mm (P <0.001) and the majority of patients with stones in the upper and middle third of the ureter were in the TUL group. The majority of patients had spontaneous excretion despite stones in the lower third and UVJ (p = 0.021).