Intravenously administered ketorolac tromethamine provided complete pain relief to a 54-year-old man with right-sided testicular pain and nausea and vomiting. The patient had a ureteral calculus documented by computed tomography. This patient's pain initially failed to respond to intravenously administered hydromorphone hydrochloride. Subsequently, he was admitted to the hospital and had operative removal of his ureteral calculus and placement of a ureteral stent. Based on their findings and review of the literature, the authors recommend that intravenous ketorolac be used as the first-line treatment for acute renal colic in patients in whom the medication is not contraindicated.