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We evaluated whether cessation of renal colic is consistent with an expelled ureteral stone or whether imaging may be indicated even in the absence of symptoms.We performed a retrospective study of patients who presented to our institution with acute renal colic and ureteral stone, and were subsequently evaluated at a followup visit where they reported complete cessation of pain for at least 72 hours.Study inclusion criteria were met by 52 patients, who reported no pain for at least 72 hours at the time of the followup visit. A persistent ureteral stone was demonstrated in 14 of the 52 patients (26%) although they denied any associated symptoms. Multivariate logistic regression did not show an association between stone size or location and the likelihood of passage in this cohort.Cessation of pain was associated with ureteral stone passage in almost 75% of this study cohort but 26% of patients still had persistent ureteral stones. We recommend routine followup imaging in all patients with ureteral stones to document stone passage and avoid the risks of silent ureteral obstruction.