Sonography vs. excretory urography in acute flank pain

New techniques of ultrasound and color Doppler in the prospective evaluation of acute renal obstruction. Do they replace the intravenous urogram?

“…Hill in the evaluation of acute flank pain felt that a KUB in addition to the US exam would increase the sensitivity and accuracy in evaluating for renal obstruction. All four cases of missed obstructing stones were evident on the plain film in his series [4]. Haddads work also suggested the KUB was helpful in identifying the level of obstruction and the size of the obstructing stone.…”

Doppler sonography in the diagnosis of urinary tract obstruction by stone

“…10 But both IVU and sonography have limitations in determining the functional significance and degree of obstructions and the cause of hydronephrosis. 3,4,11,22,30,31 We found hydronephrosis in 64% of patients (18 patients) with grayscale sonography. The sensitivity and specificity of this modality for renal obstruction were 64% and 100%, respectively; the sensitivity value is lower than that in other reports.…”

Cost-Effective Emergency Diagnosis Plan for Urinary Stone Patients Presenting with Ureteric Colic

“…The advantages of IVU are visualization of both radiopaque and radiolucent stones [1, 6, 15, 30], visualization of the urinary tract itself [35], and demonstration of obstruction [3, 14, 30, 35] as well as function of both kidneys [3, 14, 35]. However, its disadvantages are also quite obvious.…”

“…However, the fear of the potential hazards of either ionizing radiation or injected contrast media has led investigators to evaluate the use of ultrasound (US) as a safe method of triage before considering IVU [8, 9]. Although many of the recent studies concluded that US alone or in combination with a plain abdominal film of the kidney, ureter and bladder (KUB) could replace IVU when the working diagnosis was urinary stones in patients with acute flank pain [6, 10, 11, 12, 13, 14, 15], other investigators consider IVU an indispensable procedure in their proposed diagnostic algorithms [6, 10]. Only a few studies have paid attention to the diagnostic values of clinical or laboratory findings that might accompany urinary lithiasis, although they would give a clue to the diagnosis if they were considered [16].…”