Is combined ultrasound with radiography sufficient for the diagnosis of obstructive ureteric stone in patients with acute flank pain?

Thungkatikajonkit, Pornprom; Wongwaisayawan, Sirote; Wibulpolprasert, Arrug; Viseshsindh, Wit; Kaewlai, Rathachai

doi:10.4103/jmu.jmu_49_19

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…After removal of duplicate studies, our search initially retrieved 7641 studies of which 250 were assessed as full‐text documents (Figure 1). Of these, 76 studies 18–90 were included, but only 53 could be used in the quantitative meta‐analysis (see Table S1). Additional information about these studies is provided in Tables S1–S3.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

et al. 2022

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Study Objective The objective of this study was to conduct a systematic review and meta‐analysis of the diagnostic accuracy of the clinical signs, symptoms, laboratory investigations, and imaging modalities commonly used in patients with clinically suspected renal colic. Methods We conducted this systematic review and meta‐analysis according to an a priori, registered protocol (PROSPERO CRD42017055153). A literature search was performed using MEDLINE and EMBASE from inception to July 2, 2020. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies–2, calculated likelihood ratios (LRs), and applied a random‐effects model for meta‐analysis. Results Among 7641 references screened, 76 were included in the systematic review and 53 were included in the meta‐analyis. The overall pooled prevalence for ureteral stones was 63% (95% confidence interval [CI], 58%–67%). No individual demographic feature, symptom, or sign when present had an LR+ ≥2.0 for identifying ureterolithiasis. A (Sex, Timing and Origin of pain, race, presence or absence of Nausea, and Erythrocytes) STONE score ≥10 increased (sensitivity 0.49, specificity 0.91, LR 5.3 [95% CI, 4.1–6.7]) and a STONE score <6 reduced the likelihood of ureteral stones (sensitivity 0.94, specificity 0.43, LR 0.15 [95% CI, 0.10–0.22]). Standard‐dose (sensitivity 0.96, specificity 0.94, LR+ 16 [95% CI, 11–23], LR− 0.05 [95% CI, 0.03–0.07]) and low‐dose computed tomography (CT) scanning (sensitivity 0.93, specificity 0.94, LR+ 17 [95% CI, 8.8–31], LR− 0.08 [95% CI, 0.03–0.19]) were the most useful imaging techniques for identifying patients with or without ureteral stones. Conclusions Individual signs, symptoms, or the presence of microscopic hematuria do not substantially impact the likelihood of ureteral stones in patients with clinically suspected renal colic. The STONE score at high and low thresholds and a modified STONE score at a high threshold may sufficiently guide physicians’ decisions to obtain imaging. Low‐dose, non‐contrast CT imaging provides superior diagnostic accuracy compared with all other imaging index tests that are comparable with standard CT imaging. Limitations of the evidence include methodological shortcomings and considerable heterogeneity of the included studies.

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Section: Resultsmentioning

confidence: 99%

“…≥2.0 or LR− ≤0.5 (see Table S3 CT Standard dose 26,28,41,42,44,48,50,55,60,65,66,[71][72][73]75,80,81,83,85,[88][89][90][91]…”

Section: Ta B L E 2 Pooled Results Of Laboratory and Imaging Tests Fo...mentioning

confidence: 99%

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

et al. 2022

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“…CT KUB can bring about positive outcomes for radiology workflow and budgets. 6 CT KUB is recommended to be cost-effective compared to other diagnostic methods due to reduced time required for assessment, lack of administration of intravenous contrast and radiographic equipment.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, other factors such as abdominal organs, bowel gas and pelvis bone also hinder proper visualization through KUB. 6 Thus, KUB is used mostly when the CT scan is positive, and the location of the stone is already known. 7 Several researchers have put forward a similar effort of combining CT with KUB.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Unenhanced Multidetector Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) as the Initial Imaging Service in Suspected Acute Renal Colic Patients

Saleem

Balooch²,

Qayyum³

et al. 2023

PAFMJ

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Objective: To assess the role of unenhanced multidetector computed tomography (CT) of kidneys, ureters and bladder (KUB) in the initial imaging of suspected acute renal colic. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Kharian Pakistan, from Jan 2020 to Jan 2021. Methodology: One hundred and thirty-eight cases of suspected acute renal colic underwent CT-KUB. The demographic,radiological, clinical, and follow-up data were recorded for each patient. Results: There were 88(51.8%) males and 82(48.2%) females in the present study, with a mean age of 50.86±18.57 years. Out of 170 patients, only 138(81.17%) were indicated with acute findings, whereas 32(18.82%) individuals showed no acute findings.The mean stone size was found to be 4.77±0.98mm. Most of the stones had a location near the pelvic brim (n=47; 34.15%). Conclusion: The use of CT KUB should be encouraged for the evaluation of renal colic.Keywords: Acute renal colic, Computed tomography (CT), Computed tomography of Kidneys, ureter and bladder (CT-KUB).

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“…In 2018, Başeskioğlu et al designed the Osmangazi University Score, which used nausea, a history of stones, Cre, and hematuria [ 5 ]. In a meta-analysis that included the aforementioned scoring systems along with six others, Mirfazaelian et al found the STONE scoring system to be superior to others [ 1 , 19 - 22 ]. The same year, Fukuhara et al reported that the CHOKAAI score was superior to STONE [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain

Caniklioğlu¹,

Özkaya²

2021

Cureus

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Introduction Renal colic is often confused with low back pain (LBP) and other pathologies. Computed tomography (CT) is frequently used to reach a definitive diagnosis, but its use increases the exposure to radiation. Researchers have tried to predict urinary stones in patients presenting with flank pain. Several scoring systems have been introduced; however, none of them provide a prediction based on the physical examination of the patient upon initial presentation to the outpatient clinic. In this study, we aimed to investigate whether we can predict the presence of stone with visual analogue scale (VAS) questionnaire during the first admission. Materials and methods Patients with complaints of flank pain were started to be followed for three months in our urology clinic. After the definitive diagnosis was made the patients were classified into two groups: renal colic group (group 1; n=36) and the LBP group (group 2; n=30). Results In logistic regression analysis, the possibility of renal colic increased 5.4 times more per one-unit increase in the VAS score. In receiver operating characteristic (ROC) analyses, when the VAS was 4.5, the diagnosis of renal colic could be made with 88% sensitivity and 71% specificity. Conclusion If the VAS score is ≤ 4 in patients that have flank pain without limitation of movement, it is more likely to manage these patients with a simple medical treatment plan. In these patients, unnecessary ultrasonography (US) scans be reduced by 86.3% and unnecessary CT scans by 88.8%. A VAS score of ≥5 should warn the clinician about the necessity of routine urinary stone examinations.

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Is combined ultrasound with radiography sufficient for the diagnosis of obstructive ureteric stone in patients with acute flank pain?

Cited by 5 publications

References 34 publications

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

Evaluating Unenhanced Multidetector Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) as the Initial Imaging Service in Suspected Acute Renal Colic Patients

The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain

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