Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?

Chen, Michael Y. M.; Zagoria, Ronald J.

doi:10.1016/s0736-4679(98)00166-8

Cited by 112 publications

(69 citation statements)

References 11 publications

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“…6 The sensitivity of CT to detect stones ranges from 91% to 100%, with specificities ranging from 91% to 97%. [7][8][9] Because of its high sensitivity and specificity, CT is considered to be the gold standard for visualizing urinary calculi. [10][11][12][13] Computed tomography has also been shown to be useful in identifying alternate diagnoses, particularly in older patients.…”

Section: Introductionmentioning

confidence: 99%

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Edmonds

Yan

Sedran

et al. 2010

CJEM

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Objective: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit. Methods: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as "normal," "suggestive of ureterolithiasis," "ureteric stone seen" or "disease unrelated to urolithiasis." Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention. Results: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US. Conclusion: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.Keywords: renal colic, urolithiasis, urologic intervention, ultrasonography, emergency department RÉSUMÉObjectif : Le tomodensitogramme est une technique d'imagerie utilisée pour détecter les calculs rénaux. Cependant, on se préoccupe de l'exposition cumulative aux rayonnements associés aux appareils de tomodensitométrie. On utilise les échographies pour diagnostiquer l'urolithiase, évi-tant ainsi l'exposition aux rayonnements. L'objectif de cette étude était de déterminer la capacité des échographies à repérer les patients atteints de colique néphrétique et pré -sentant un faible risque de devoir subir une intervention urologique dans les 90 jours suivant leur visite à l'urgence. Méthodes : Nous avons réalisé une étude rétrospective des dossiers médicaux pour tous les patients adultes qui avaient subi, sur une période d'un an, une échographie rénale prescrite à l'urgence pour suspicion d'urolithiase. Nous avons procédé à l'extraction de données en double pour tous les rapports d'imagerie, et les résultats des échographies ont été classés ainsi : normaux, évocateurs d'une urolithiase, calcul rénal détecté, ou maladie non associée à une l'urolithiase. Nous avons examiné les dossiers médicaux pour déterminer combien de patients avaient subi ultérieurement une tomodensitométrie et une interventi...

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Section: Introductionmentioning

confidence: 99%

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Edmonds

Yan

Sedran

et al. 2010

CJEM

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“…The mean stone diameters were 6.2 (range, 4-18) mm in group A and 6.6 (range, 3-20) mm in group B (P > .05). In the clinical follow up, the mean time for passage of the stones was 7.4 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] days.…”

Section: Resultsmentioning

confidence: 99%

“…11 Radiologic imaging modalities have been developed enormously in recent years, and, today, noncontrast spiral CT is accepted as the best imaging modality for diagnosis of ureteral stones because of its nearly 100% sensitivity and high specificity rates. [2][3][4] Conversely, spiral CT has some disadvantages because it is a method that includes ionizing radiation and also is more expensive than ultrasonography. 5 Because of ionizing radiation, it is contraindicated in pregnant patients.…”

Section: Discussionmentioning

confidence: 99%

Is Fluid Ingestion Really Necessary During Ultrasonography for Detecting Ureteral Stones?

Özden

Göğüş²,

Türkölmez³

et al. 2005

Journal of Ultrasound in Medicine

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Objective. Ultrasonographic evaluation of ureteral stones is usually performed after fluid ingestion for filling the bladder to visualize the ureterovesical junction better. We hypothesized that water ingestion may decrease the imaging quality of ultrasonography for detecting ureter stones. In our prospective randomized study, the accuracy of ultrasonography for detecting ureteral stones performed with or without fluid intake were evaluated. Methods. The study population comprised 150 consecutive patients thought to have ureteral stones who underwent ultrasonography. Patients were divided into 2 groups. Group A patients ingested 500 mL of water to distend the bladder before ultrasonographic examination. Group B patients were restricted from drinking any water at least 4 hours before the procedure. Results. Ultrasonography showed 35 (67.30%) of 52 stones in group A and 68 (93.15%) of 73 stones in group B. The difference of detection rates between the 2 groups was statistically significant (P < .001). The greatest improvement in detection rates was noted in the middle ureter stones. The evaluated sensitivity and specificity rates for group A were 67% and 82%, respectively, and those for group B were 93% and 94%. When the 2 methods were compared, total accuracy of ultrasonography increased from 71% in group A to 93% in group B. Conclusions. This prospective randomized study showed that the diagnostic accuracy of ultrasonography for detection of middle ureteral stones increased significantly when performed without any water ingestion before the procedure. We recommend that patients thought to have ureteral stones should be first examined without any fluid ingestion.

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“…1,[4][5][6][7][8][9][10][11][12][13] In particular, using CT for following up residual fragments after stone treatment can reduce unnecessary follow-up ureteroscopies by up to 20% and can therefore save theatre time and cost. 13 Conversely, our results suggest non-contrast CT is inferior in identifying stones when a ureteral stent is in situ.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

Tang

Attwell-Heap

2011

annals

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Non-contrast helical computed tomography (CT) is well validated in diagnosing urinary tract stone disease. It has been shown that this technique is superior to all other imaging modalities with a 97% sensitivity and a 96% specificity in detecting renal tract calculi.1 Nevertheless, using CT to diagnose stones in the urinary tract with a ureteral stent in situ is more difficult due to the complexity in differentiating between the stent and stones. Tanrikut et al 2 and Yoshida et al 3 suggested that stone density has a Hounsfield unit value of between 400 and 1,600 whereas a ureteral stent has a Hounsfield unit value of over 2,000. When using abdominal window settings to analyse CT, it is difficult to differentiate between stent and stone because they would have a similar bright white appearance. By using bone window settings, however, there would be a visual distinction between the stent and stone. 2,3The method of using bone window settings in the diagnosis of a stone with a stent in situ has not yet been validated. In our study, we attempted to validate this method by comparing the results of CT and ureteroscopy in identification of renal tract stones with a ureteral stent in situ. Ureteroscopy is often perceived as the current 'gold standard' as it allows clinicians to directly visualise stones in the renal tract. In spite of this, it is still possible to miss small stones with ureteroscopy.If CT were proven to be as good as ureteroscopy, then clinicians could safely rely on CT to pre-operatively diagnose stone clearance with a stent in situ. This would have implications for the type of surgery offered to patients, namely local anaesthetic removal of ureteral stents versus the more invasive and more time consuming ureteroscopy procedure. This would ultimately offer improvements in theatre efficiency. MethodsAll patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively.Helical CT was performed using a 1mm slice collimation without intravenous or oral contrast administration. CT was reported in bone window settings to determine the presence and size of stones by consultant radiologists from the same department. The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in sit...

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Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?

Cited by 112 publications

References 11 publications

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Is Fluid Ingestion Really Necessary During Ultrasonography for Detecting Ureteral Stones?

Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

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