Relationship Between Duration of Pain and Secondary Signs of Obstruction  of the Urinary Tract on Unenhanced Helical CT

Varanelli, Michael J.; Coll, Deirdre M.; Levine, Jessica L.S.; Rosenfield, Arthur T.; Smith, Robert C.

doi:10.2214/ajr.177.2.1770325

Cited by 64 publications

(61 citation statements)

References 14 publications

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“…2 Lastly, obstructing stones may be associated with a longer duration of pain. 6 In the absence of absolute indications for acute intervention, such as signs of urinary tract infection (UTI), renal failure, or unrelenting pain, there remains uncertainty as to whether patients presenting with unilateral obstructing calculi can be treated conservatively or warrant more prompt urological management. Our study aimed to determine whether unilateral, obstructing ureteric calculi identified on computed tomography (CT) at the time of renal colic presentation in the ED, independent of other factors, was associated with an increased likelihood of urological intervention.…”

Section: Introductionmentioning

confidence: 99%

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

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Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods:We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67-2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09-0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07-1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

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Section: Introductionmentioning

confidence: 99%

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

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“…The indirect, by order of frequency, include: hydroureter, hydronephrosis, striation of the perirenal fat, homolateral increase in the renal size, visible ureteral wall around the calculus (halo sign) and periureteral heterogeneity adjacent to the calculus (1,11,12) . Some of these secondary signs may be present in patients without a disease caused by ureteral calculus (12) , may be precociously absent, and may become more noticeable with time (13) . Other more recently described secondary findings are: unilateral absence of a hyperdense medullary pyramid (11) and decrease in attenuation of an acutely obstructed renal parenchyma in comparison with the contralateral kidney (14) .…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we have nullified eventual differences resulting from prostatic enlargement in elderly men with vesical floor elevation, alterations in the pelvic floor level resulting from parturition, and anaof uric acid, with densities ranging between 300 and 400 UH (8) . Only exceptions are calculi resulting from deposition of protease inhibitors (Indinavir), which should be taken into consideration in patients undergoing treatment for the human immunodeficiency syndrome and with indirect renal calyceal system obstructive signs (11,13) . Studies performed since Smith et al (6) , in 1995, have found negative predictive values between 91% and 100%, positive predictive values between 96% and 100%, sensitivity between 95% and 100%, and specificity between 92% and 100%, for detection of ureteral calculi with unenhanced helical CT (4) , with excellent reproducibility, independently from the radiologist experience (1,9) .…”

Section: Discussionmentioning

confidence: 99%

Definição do nível da junção ureterovesical pela tomografia computadorizada

et al. 2006

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OBJECTIVE: To define, by means of computed tomography, the level of ureteral implantation into de bladder. MATERIALS AND METHODS: We have measured the distances from the ureteral meatus to the acetabulum, and to the superior margin of the pubic symphysis, as well as the bladder volume, using contrast enhanced computed tomography of the pelvis in 46 patients (31 male and 15 female) in the age range between 18 and 45 years, with at least one of the ureteres filled with excreted contrast material. The Student t test has been applied to determine eventual statistically significant differences between groups. RESULTS: The level of ureteral implantation into the bladder was, on average, 10.6 ± 8.1 mm below the acetabular roof, and 29.7 ± 9.5 mm above the superior margin of the pubic symphysis. In patients with bladder repletion volume of < 200 ml and ≥ ≥ ≥ ≥ ≥ 200 ml, the level of ureteral implantation into the bladder was, respectively, on average, 11.6 ± 7.3 mm and 10.2 ± 8.4 mm below the acetabular roof (p = 0.61), and 28.3 ± 7.3 mm and 30.3 ± 10.2 mm above the superior margin of the pubic symphysis (p = 0.52), and in male and female men patients, respectively, on average, 11.8 ± 8.0 mm and 8.3 ± 8.0 mm below the acetabular roof (p = 0.17), and 27.7 ± 9.2 mm and 33.9 ± 8.8 mm above the superior margin of the pubic symphysis (p = 0.34). CONCLUSION: Calcifications located < 3 cm below the acetabular roof and < 1.5 cm above the superior margin of the pubic symphysis probably do not represent ureteral calculi. Vesical repletion or sex have no significant influence on the ureteral meatus position. Keywords: Calculus; Ureter; Ureteral obstruction; Lithiasis; X-ray computed tomography.Definição do nível da junção ureterovesical pela tomografia computadorizada. OBJETIVO: Definir o nível da implantação ureteral na bexiga através da tomografia computadorizada. MA-TERIAIS E MÉTODOS: Através de tomografia computadorizada da pelve com contraste endovenoso de 46 pacientes (31 homens e 15 mulheres) com idade entre 18 e 45 anos, com pelo menos um dos ureteres contrastado pelo contraste excretado, medimos as distâncias do meato ureteral até o teto acetabular e a borda superior da sínfise púbica, além do volume da bexiga. Utilizamos o teste t de Student para avaliar se houve diferenças estatísticas entre grupos. RESULTADOS: O nível da implantação ureteral na bexiga foi, em média, 10,6 ± 8,1 mm abaixo do teto acetabular e, em média, 29,7 ± 9,5 mm acima da borda superior da sínfise púbica. Nos pacientes com volume de repleção vesical menor que 200 ml e maior ou igual a 200 ml os níveis da implantação ureteral na bexiga foram, em média, 11,6 ± 7,3 mm e 10,2 ± 8,4 mm abaixo do teto acetabular (p = 0,61) e, em média, 28,3 ± 7,3 mm e 30,3 ± 10,2 mm acima da borda superior da sínfise púbica (p = 0,52), respectivamente, e nos pacientes do sexo masculino e feminino foram, em média, 11,8 ± 8,0 mm e 8,3 ± 8,0 mm abaixo do teto acetabular (p = 0,17) e, em média, 27,7 ± 9,2 mm e 33,9 ± 8,8 mm acima da borda superior da sínfise púbica (p = 0,34),...

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“…Direct stone identification is diagnostic for lithiasis, but a stone may not be easily identified due to its small size, low attenuation, respiratory movement artifacts, inadequacy of retroperitoneal fat tissue, phleboliths, and recent stone passage; under these circumstances, the presence of secondary signs carries great importance for prediction of the duration of stone disease and its management (37,38). The secondary signs include asymmetric perinephric fat stranding, dilatation of the intrarenal collecting system, hydroureter, tissue rim sign, unilateral renal enlargement and pale kidney, and unilateral absence of white renal pyramids.…”

Section: Secondary Findingsmentioning

confidence: 99%

MDCT technique and imaging findings of urinary stone disease: an expanded review

Türkbey

Akpınar²,

Özer³

et al. 2008

Diagn Interv Radiol

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Relationship Between Duration of Pain and Secondary Signs of Obstruction of the Urinary Tract on Unenhanced Helical CT

Cited by 64 publications

References 14 publications

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Definição do nível da junção ureterovesical pela tomografia computadorizada

MDCT technique and imaging findings of urinary stone disease: an expanded review

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