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Place of non-contrast computed tomography for evaluation of flank pain and suspected urinary stone in emergency service

Year 2014, Volume: 36 Issue: 1, 42 - 50, 17.02.2014
https://doi.org/10.7197/cmj.v36i1.5000006255

Abstract

Abstract

Aim. With an intent to present our experience with the non-contrast computed tomography (CT) during the work-up of patients admitted with acute urinary complaints in the emergency service, we reviewed our clinical and non-contrast CT imaging data of patients presented with flank pain and suspected urinary stone. Methods. Clinical and non-contrast CT with ultrasound examinations performed at our Emergency and Radiology Departments in 2011 were reviewed retrospectively in 102 adult urinary stone patients in acute conditions. Results. In 102 patients with suspected urinary stones, 95 had urinary stones detected with non-contrast CT. Ultrasonography provided helpful findings for the evaluation of calyceal dilatation and hydronephrosis. There was no specific side and level preference of urinary stones in the urinary tract. There was no hydronephrosis in for the percent of urinary stone patients. The BUN and creatinine levels in the patients with multiple urinary stones were higher than those in the patients with single urinary stones (p<0.05). Although single urinary stone was more common, overall there was no specific propensity of single and multiple urinary stones to kidney, ureter, and bladder. Conclusions. In this study, we attempted to reveal the efficacy of non-contrast CT during the diagnosis of urinary stones in patients presenting to the Emergency Department in acute conditions. According to our findings, non-contrast CT with ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Further studies are needed to shed light on the long-term effects of the choice of this pathway on the clinicoradiologic diagnosis of urinary stone patients. According to our findings, non-contrast CT with ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Further studies are needed to shed light on the long-term effects of the choice of this pathway on the outcome of urinary stone patients.

Keywords: Urinary stone, emergency department, non-contrast computed tomography, ultrasonography

 

Özet

Amaç. Acil servise akut üriner şikayetlerle başvuran hastaların incelenmesi sırasında kontrastsız bilgisayarlı tomografi (BT) ile ilgili tecrübelerimizi sunmak amacı ile yan ağrısı ile gelen ve şüpheli üriner taşı olan hastaların klinik ve kontrastsız (BT) verilerini değerlendirdik. Yöntem. Klinik, kontrastsız BT ve ultrasonografi (US) incelemeleri 2011 yılında acil ve radyoloji departmanlarında yapılan 102 adet erişkin akut üriner taş hastasında retrospektif olarak değerlendirildi. Bulgular. Değerlendirilen 102 olgunun 95 tanesinde kontrastsız BT'de taşı mevcuttu. Ultrasonografi kaliks dilatasyonu ve hidronefrozun değerlendirilmesinde yardımcı bulgular sağladı. Üriner sistemde üriner taşların spesifik bölgesi ve seviye tercihi bulunmamaktaydı. Multipl üriner taşı olan hastalarda BUN ve kreatinin seviyeleri tek üriner taşı olan hastalardan daha yüksekti (p<0,05). Tek üriner taş sayısı daha sık olduğu halde tek ve multipl taşların böbrek, üreter ve mesanede bulunma oranı özellik göstermiyordu. Sonuçlar. Bu çalışmada akut durumlarda Acil servise başvuran hastalarda üriner taşların tanısı sırasında kontrastsız BT'nin etkinliğini göstermeyi amaçladık. Bizim bulgularımıza göre US ile birlikte kontrastsız BT Acil serviste üriner taşlı hastalar için tanısal modalitedir. Üriner taşlı olguların klinikoradyolojik tanıları üzerinde önerdiğimiz yolun tercih edilmesinin etkilerini aydınlatmak için daha fazla çalışmalara ihtiyaç vardır.

Anahtar sözcükler: Üriner taş, acil servis, non-kontrast bilgisayarlı tomografi, ultrasonografi

References

  • Wang JH, Shen SH, Huang SS, Chang CY. Prospective comparison of unenhanced spiral computed tomography and intravenous urography in the evaluation of acute renal colic. J Chin Med Assoc 2008; 71: 30-6.
  • Rodríguez Alonso A, Pérez García D, Ojea Calvo A, Rodríguez Iglesias B, Alonso Rodrigo A, Barros Rodríguez JM, Benavente Delgado J, Nogueira March JL. Value of non-contrast helical computerized tomography in nephrotic colic assessment. Actas Urol Esp 1999; 23: 772-7.
  • Franco A, Tomás M, Alonso-Burgos A. Intravenous urography is died. Long live the computerized tomography! Actas Urol Esp 2010; 34: 764-74.
  • Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med 2012; 5: 525-33.
  • Jindal G, Ramchandani P. Acute flank pain secondary to urolithiasis: Radiologic evaluation and alternate diagnoses. Radiol Clin North Am 2007; 45: 395-410.
  • Sandhu C, Anson KM, Patel U. Urinary tract stones--Part I: role of radiological imaging in diagnosis and treatment planning. Clin Radiol 2003; 58: 415-21.
  • Winkel RR, Kalhauge A, Fredfeldt KE. The usefulness of ultrasound colourDoppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography. Ultrasound Med Biol 2012; 38: 1180-7. Magrill D, Patel U, Anson K. Impact of imaging in urolithiasis treatment planning. Curr Opin Urol 2013; 23: 158-63.
  • Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 1995; 194: 789-94.
  • Saw KC, McAteer JA, Monga AG, Chua GT, Lingeman JE, Williams JC Jr. Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. AJR Am J Roentgenol 2000; 175: 329-32.
  • Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003; 13: 418-24.
  • Kambadakone AR, Eisner BH, Catalano OA, Sahani DV. New and evolving concepts in the imaging and management of urolithiasis: urologists' perspective. Radiographics 2010; 30: 603-23.
  • Eaton SH, Cashy J, Pearl JA, Stein DM, Perry K, Nadler RB. Admission rates and costs associated with emergency presentation of urolithiasis: analysis of the Nationwide Emergency Department Sample 2006-2009. J Endourol 2013; 27: 1535Rao S. Acute Obstructive Uropathy Imaging. Available at: www.medscape.com (Accessed on January 2014).
  • Smith RC, Verga M, Dalrymple N, McCarthy S, Rosenfield AT. Acute ureteral obstruction: value of secondary signs of helical unenhanced CT. AJR Am J Roentgenol 1996; 167: 1109-13.
  • Johnson EK, Faerber GJ, Roberts WW, Wolf JS Jr, Park JM, Bloom DA, Wan J. Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi? Urology 2011; 78: 662-6.
  • Tisdale BE, Siemens DR, Lysack J, Nolan RL, Wilson JW. Correlation of CT scan versus plain radiography for measuring urinary stone dimensions. Can J Urol 2007; 14: 3489-92.
  • Wang LJ, Wong YC, Chuang CK, Chu SH, Chen CS, See LC, Chiang YJ. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis. Eur Radiol 2005; 15: 2238-43.
  • Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, Nozumi K, Suzuki K. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a largescale study at a single institution. J Endourol 2005; 19: 768-73.
  • Liu W, Esler SJ, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW. Low-dose nonenhanced helical CT of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 2000; 215: 51-4.
  • Lin WC, Uppot RN, Li CS, Hahn PF, Sahani DV. Value of automated coronal reformations from 64-section multidetector row computerized tomography in the diagnosis of urinary stone disease. J Urol 2007; 178: 907-11.
  • Metser U, Ghai S, Ong YY, Lockwood G, Radomski SB. Assessment of urinary tract calculi with 64-MDCT: The axial versus coronal plane. AJR Am J Roentgenol 2009; 192: 1509-13.
  • Hyams ES, Matlaga BR, Korley FK. Practice patterns in the emergency care of kidney stone patients: an analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Can J Urol 2012; 19: 6351-9.
  • Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR. Acute abdominal pain: is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? J Magn Reson Imaging 2010; 32: 1012-23.
  • Ripollés T, Martínez-Pérez MJ, Vizuete J, Miralles S, Delgado F, Pastor-Navarro T. Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact. Abdom Imaging 2013; 38: 863-9.
  • Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emerg Med Australas 2013; 25: 422-6.

Original research-Orijinal araştırma

Year 2014, Volume: 36 Issue: 1, 42 - 50, 17.02.2014
https://doi.org/10.7197/cmj.v36i1.5000006255

Abstract

Amaç. Acil servise akut üriner şikayetlerle başvuran hastaların incelenmesi sırasında kontrastsız bilgisayarlı tomografi (BT) ile ilgili tecrübelerimizi sunmak amacı ile yan ağrısı ile gelen ve şüpheli üriner taşı olan hastaların klinik ve kontrastsız (BT) verilerini değerlendirdik. Yöntem. Klinik, kontrastsız BT ve ultrasonografi (US) incelemeleri 2011 yılında acil ve radyoloji departmanlarında yapılan 102 adet erişkin akut üriner taş hastasında retrospektif olarak değerlendirildi. Bulgular. Değerlendirilen 102 olgunun 95 tanesinde kontrastsız BT'de taşı mevcuttu. Ultrasonografi kaliks dilatasyonu ve hidronefrozun değerlendirilmesinde yardımcı bulgular sağladı. Üriner sistemde üriner taşların spesifik bölgesi ve seviye tercihi bulunmamaktaydı. Multipl üriner taşı olan hastalarda BUN ve kreatinin seviyeleri tek üriner taşı olan hastalardan daha yüksekti (p<0,05). Tek üriner taş sayısı daha sık olduğu halde tek ve multipl taşların böbrek, üreter ve mesanede bulunma oranı özellik göstermiyordu. Sonuçlar. Bu çalışmada akut durumlarda Acil servise başvuran hastalarda üriner taşların tanısı sırasında kontrastsız BT'nin etkinliğini göstermeyi amaçladık. Bizim bulgularımıza göre US ile birlikte kontrastsız BT Acil serviste üriner taşlı hastalar için tanısal modalitedir. Üriner taşlı olguların klinikoradyolojik tanıları üzerinde önerdiğimiz yolun tercih edilmesinin etkilerini aydınlatmak için daha fazla çalışmalara ihtiyaç vardır.

References

  • Wang JH, Shen SH, Huang SS, Chang CY. Prospective comparison of unenhanced spiral computed tomography and intravenous urography in the evaluation of acute renal colic. J Chin Med Assoc 2008; 71: 30-6.
  • Rodríguez Alonso A, Pérez García D, Ojea Calvo A, Rodríguez Iglesias B, Alonso Rodrigo A, Barros Rodríguez JM, Benavente Delgado J, Nogueira March JL. Value of non-contrast helical computerized tomography in nephrotic colic assessment. Actas Urol Esp 1999; 23: 772-7.
  • Franco A, Tomás M, Alonso-Burgos A. Intravenous urography is died. Long live the computerized tomography! Actas Urol Esp 2010; 34: 764-74.
  • Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med 2012; 5: 525-33.
  • Jindal G, Ramchandani P. Acute flank pain secondary to urolithiasis: Radiologic evaluation and alternate diagnoses. Radiol Clin North Am 2007; 45: 395-410.
  • Sandhu C, Anson KM, Patel U. Urinary tract stones--Part I: role of radiological imaging in diagnosis and treatment planning. Clin Radiol 2003; 58: 415-21.
  • Winkel RR, Kalhauge A, Fredfeldt KE. The usefulness of ultrasound colourDoppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography. Ultrasound Med Biol 2012; 38: 1180-7. Magrill D, Patel U, Anson K. Impact of imaging in urolithiasis treatment planning. Curr Opin Urol 2013; 23: 158-63.
  • Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 1995; 194: 789-94.
  • Saw KC, McAteer JA, Monga AG, Chua GT, Lingeman JE, Williams JC Jr. Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. AJR Am J Roentgenol 2000; 175: 329-32.
  • Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003; 13: 418-24.
  • Kambadakone AR, Eisner BH, Catalano OA, Sahani DV. New and evolving concepts in the imaging and management of urolithiasis: urologists' perspective. Radiographics 2010; 30: 603-23.
  • Eaton SH, Cashy J, Pearl JA, Stein DM, Perry K, Nadler RB. Admission rates and costs associated with emergency presentation of urolithiasis: analysis of the Nationwide Emergency Department Sample 2006-2009. J Endourol 2013; 27: 1535Rao S. Acute Obstructive Uropathy Imaging. Available at: www.medscape.com (Accessed on January 2014).
  • Smith RC, Verga M, Dalrymple N, McCarthy S, Rosenfield AT. Acute ureteral obstruction: value of secondary signs of helical unenhanced CT. AJR Am J Roentgenol 1996; 167: 1109-13.
  • Johnson EK, Faerber GJ, Roberts WW, Wolf JS Jr, Park JM, Bloom DA, Wan J. Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi? Urology 2011; 78: 662-6.
  • Tisdale BE, Siemens DR, Lysack J, Nolan RL, Wilson JW. Correlation of CT scan versus plain radiography for measuring urinary stone dimensions. Can J Urol 2007; 14: 3489-92.
  • Wang LJ, Wong YC, Chuang CK, Chu SH, Chen CS, See LC, Chiang YJ. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis. Eur Radiol 2005; 15: 2238-43.
  • Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, Nozumi K, Suzuki K. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a largescale study at a single institution. J Endourol 2005; 19: 768-73.
  • Liu W, Esler SJ, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW. Low-dose nonenhanced helical CT of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 2000; 215: 51-4.
  • Lin WC, Uppot RN, Li CS, Hahn PF, Sahani DV. Value of automated coronal reformations from 64-section multidetector row computerized tomography in the diagnosis of urinary stone disease. J Urol 2007; 178: 907-11.
  • Metser U, Ghai S, Ong YY, Lockwood G, Radomski SB. Assessment of urinary tract calculi with 64-MDCT: The axial versus coronal plane. AJR Am J Roentgenol 2009; 192: 1509-13.
  • Hyams ES, Matlaga BR, Korley FK. Practice patterns in the emergency care of kidney stone patients: an analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Can J Urol 2012; 19: 6351-9.
  • Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR. Acute abdominal pain: is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? J Magn Reson Imaging 2010; 32: 1012-23.
  • Ripollés T, Martínez-Pérez MJ, Vizuete J, Miralles S, Delgado F, Pastor-Navarro T. Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact. Abdom Imaging 2013; 38: 863-9.
  • Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emerg Med Australas 2013; 25: 422-6.
There are 24 citations in total.

Details

Primary Language English
Journal Section Medical Science Research Articles
Authors

İsmail Şalk

Ali Çetin

İlhan Korkmaz

Ferhat Sezer

Mehmet Atalar

Publication Date February 17, 2014
Published in Issue Year 2014Volume: 36 Issue: 1

Cite

AMA Şalk İ, Çetin A, Korkmaz İ, Sezer F, Atalar M. Place of non-contrast computed tomography for evaluation of flank pain and suspected urinary stone in emergency service. CMJ. March 2014;36(1):42-50. doi:10.7197/cmj.v36i1.5000006255