One year’s clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic

Greenwell, Tamsin; Woodhams, S.; Denton, E.R.M.; Mackenzie, Alistair; Rankin, Sheila; Popert, R.

doi:10.1046/j.1464-410x.2000.00605.x

Cited by 43 publications

(46 citation statements)

References 20 publications

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“…CT KUB allows a rapid, contrast-free, anatomically accurate diagnosis of urolithiasis with a sensitivity of 97-98% and a specificity of 96-100% [14]. It has become the gold standard in the imaging of suspected acute renal colic.…”

Section: Discussionmentioning

confidence: 99%

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

Patatas¹,

Panditaratne²,

Wah³

et al. 2012

The British Journal of Radiology

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Objectives: The objective of our study is to determine the positive rate for urolithiasis in male and female patients, and evaluate whether there has been any change at our institution in the use and outcome of unenhanced multidetector CT (CT KUB) performed in the emergency department (ER) for patients presenting with suspected acute renal colic. Methods: A retrospective review of all 1357 consecutive cases between August 2007 and August 2009 admitted to the ER and investigated with CT KUB. Results: The positive rate for urolithiasis was 47.5% and the rate of other significant findings was 10%. Female patients had a significantly lower positive rate than male patients (26.8% vs 61.6%, p<0.001). Urological intervention was required in 37% and these patients had a larger average stone size. In young female patients with a significantly sized ureteric calculus (>4 mm), the presence of hydronephrosis vs no hydronephrosis was 83% vs 17%, respectively. Among them, only three patients required ureteroscopy for stone removal. Conclusion: Contrary to other studies there has been no “indication creep” in the use of CT KUB at our institution. However, the young female patient presenting with suspected urolithiasis presents a particular diagnostic problem, and the significant percentage of negative examinations in females implies that an improvement in current practice is needed. The indiscriminate use of CT KUB in all female patients with flank pain should be avoided, and it is suggested that they should be initially evaluated with ultrasound to detect the presence of hydronephrosis.

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Section: Discussionmentioning

confidence: 99%

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

Patatas¹,

Panditaratne²,

Wah³

et al. 2012

The British Journal of Radiology

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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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“…However, the radiation dose of an unenhanced CT, let alone a CT with contrast, is substantially higher than an IVU (Table 2). 6 There are some advantages to the IVU. In every acute hospital in the UK, there is the possibility of performing an emergency IVU 24 h a day, 365 days a year.…”

Section: For Debatementioning

confidence: 99%

Is There a Role for the Intravenous Urogram in the 21st Century?

Whitfield

2006

annals

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For debate Over the last two decades, there have been major advances in methods of medical imaging that have brought great benefits to patients both for diagnosis and for treatment. There has been an increasing tendency for some of these new imaging modalities to be dependent on highly sophisticated technology. The belief has developed amongst doctors who use these techniques that newer is necessarily better. Just as patients (and some doctors) now often believe that anything done with a laser represents the best that can be offered, so there is a tendency to demand that newer techniques in imaging should always be offered as the preferred option. In urological practice that philosophy is questionable.

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One year’s clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic

Cited by 43 publications

References 20 publications

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

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

Is There a Role for the Intravenous Urogram in the 21st Century?

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