To systematically evaluate the efficacy and safety of acupuncture-related interventions for renal colic caused by upper urinary tract stones, and to compare the clinical effects of acupuncture alone and acupuncture combined with conventional pharmacological treatment versus pharmacological treatment alone.

This study was a systematic review and meta-analysis of randomized controlled trials. MEDLINE (PubMed), Web of Science, Embase, the Cochrane Central Register of Controlled Trials, CNKI, Wanfang, VIP, and CBM were searched from database inception to March 2026. Eligible studies were randomized controlled trials comparing acupuncture-related interventions with conventional pharmacological treatment, or acupuncture combined with conventional pharmacological treatment versus pharmacological treatment alone. The main outcomes were pain score, analgesic response rate, time to pain relief, and adverse event rate. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and meta-analysis was performed using RevMan 5.4.

A total of 16 randomized controlled trials involving 1417 patients were included. Meta-analysis showed that, compared with conventional pharmacological treatment, both acupuncture alone and acupuncture combined with conventional pharmacological treatment significantly reduced pain scores. The pooled effect size was MD = -2.71 (95% CI -3.05 to -2.37; P < 0.00001) for acupuncture alone and MD = -1.36 (95% CI -1.68 to -1.03; P < 0.00001) for combination treatment.
For analgesic response rate, acupuncture alone was superior to conventional pharmacological treatment (90.49% vs 74.38%; RR = 1.09, 95% CI 1.02 to 1.18; P = 0.02), and acupuncture combined with conventional pharmacological treatment was also superior to pharmacological treatment alone (93.84% vs 80.80%; RR = 1.14, 95% CI 1.05 to 1.23; P = 0.001).
Time to pain relief was shorter in both the acupuncture-alone group and the combination group than in the control group, with pooled MD values of -14.86 minutes and -4.89 minutes, respectively.
In terms of safety, adverse event rates were lower in both the acupuncture-alone group and the combination group than in the control group, with RR values of 0.42 and 0.36, respectively.

These findings suggest that acupuncture-related interventions, whether used alone or combined with conventional pharmacological treatment, may be more effective than pharmacological treatment alone for relieving renal colic caused by upper urinary tract stones, with greater pain reduction, faster onset of relief, and fewer adverse events. Subgroup comparison further suggests that adding acupuncture to conventional pharmacological treatment may provide additional clinical benefit. However, the findings should be interpreted with caution because of variations in methodological quality and intervention types across the included studies.

Acupuncture-related interventions may have beneficial analgesic effects and acceptable safety for renal colic caused by upper urinary tract stones. Both acupuncture alone and acupuncture combined with conventional pharmacological treatment showed potential clinical value. Combination treatment may further improve efficacy and reduce adverse events. However, the current evidence remains limited, and more rigorously designed, well-reported, high-quality randomized controlled trials are needed.