Low back pain is often a symptom of many diseases of the urinary tract system, and if it originates from ureteral obstruction complicated by infection, treatment must be prompt or it can lead to renal or systemic problems. The nature of the pain is suggestive of the etiology, and important features include whether the low back pain is limited or involved, acute/chronic/recurrent, and the severity and persistence. It may also be accompanied by associated symptoms to aid in the diagnosis. Obstruction of the upper ureter or renal pelvis can radiate to the ipsilateral scrotum, and the degree of pain correlates with the degree of obstruction. Stones falling into the ureter can cause intense pain, but chronic obstruction can be mild or asymptomatic. Severe ureteral obstruction can cause irreversible damage to kidney function. Non-specific symptoms often associated with back pain include fever, nausea and vomiting, and tachycardia. Fever means that infection is present above the ureteral obstruction and is highly likely to lead to sepsis. Hematuria can help to understand the cause of urinary tract pathology, but some patients do not have hematuria. Ureteral stones are the most common cause of low back pain, other similarities are obstruction due to blood clots or detached renal papillae. Blood clots are a manifestation of the kidney being a series of renal lesions, of which tumors are the most predominant. Painkiller abuse or diabetic patients often present with necrotic detachment of the renal papillae. The pain of chronic ureteral obstruction is mostly not severe, and some back pain is associated with congenital ureteral malformations, such as stenosis of the ureteropelvic junction. Bilateral ureteral obstruction or isolated kidney (including functional isolated kidney) ureteral obstruction can cause renal failure and, in addition to pain, headache, apathy, drowsiness, loss of appetite, muscle twitching, hypertension, and growth retardation in children. Pain in inflammatory renal lesions is mostly limited and non-acute, accompanied by other symptoms such as fever, elevated white blood cells and bacteremia. Low back pain due to thoracic and abdominal lesions is different from typical “renal colic” and is more diffuse, dull and less intense, similar to chronic ureteral obstruction. The correct diagnosis requires consideration of the above etiology, together with other related symptoms, careful physical examination, urinalysis and other laboratory analysis, and imaging studies.