Comparison of Non-contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi

Lim, Go San; Jang, Seok Heun; Son, Jeong Hwan; Lee, Jae Won; Hwang, Jae Seung; Lim, Chae Hong; Kim, Dae Ji; Cho, Dae Sung

doi:10.4111/kju.2014.55.2.120

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…Larson et al [ 10 ] reviewed CT use in a sample that included all patients who were evaluated in the ED and found a 16% compound annual growth rate, which outpaced the increase in CT use in in-patient and out-patient settings. Lim et al [ 2 ] retrospectively reviewed the medical records of 2,180 patients with acute flank pain from 2008 to 2012 in an ED in Korea and reported that NECT use increased from 0.5% of the cases in 2008 to 66.6% of the cases in 2012. Reasons for this increase include easy accessibility, rapid image acquisition time, and superior image quality.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients can suffer from severe pain, particularly during the first attack; thus, a definitive diagnosis of the cause of flank pain is necessary. Nonenhanced computed tomography (NECT) is a very useful diagnostic tool for evaluating urolithiasis in the ED and has been described as the best imaging tool for confirming the diagnosis of urolithiasis [ 2 , 3 ]. And NECT is effective for detecting conditions other than urinary stones that can cause renal colic; it is less time consuming than intravenous urography (IVU), particularly in patients with obstructing calculi; it reduces the risk of complications from intravenous contrast media [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Nonenhanced Computed Tomography for Diagnosing Urolithiasis without Pyuria in the Emergency Department

Lee

Chang

Kim

et al. 2015

BioMed Research International

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We compared the clinical utility of nonenhanced computed tomography (NECT) and intravenous urography (IVU) in patients with classic symptoms of renal colic without evidence of a urine infection. This was a retrospective analysis of IVU and NECT performed in adult patients with suspected renal colic at an emergency department between January 2005 and December 2013. The records of all patients in NECT and IVU groups were reviewed, and the patients were categorized according to the cause of their symptoms. A total of 2218 patients were enrolled. Of these patients, 1525 (68.8%) underwent IVU and 693 (31.2%) underwent NECT. The patients in NECT group were older (45.48 ± 14.96 versus 42.37 ± 13.68 years, p < 0.001), had less gross hematuria (7.6 versus 2.9%, p < 0.001), and were admitted more often (18.6 versus 12.0%, p < 0.001) than the patients in IVU group. Urinary stones were detected in 1413 (63.7%) patients. NECT had a higher detection rate of urolithiasis than IVP (74.0 versus 59.0%, p < 0.001). No significant difference was observed in the incidence of urinary stones greater than 4mm between groups from the radiologic findings (p = 0.79) or the full medical record review (p = 0.87).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of Nonenhanced Computed Tomography for Diagnosing Urolithiasis without Pyuria in the Emergency Department

Lee

Chang

Kim

et al. 2015

BioMed Research International

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“…More commonly used in the past, recent consensus considers alternative imaging modalities, including ultrasound, CT, and MRI, to be superior for the diagnosis of urolithiasis. 58–61 In general, the routine use of IVP has been called into question and correspondingly declined in recent years. 62 The relatively low utility of IVP is especially prominent in pregnancy when one considers the radiation dose exposure secondary to serial radiographic imaging in IVU as well as the need for intravenous contrast.…”

Section: Diagnosismentioning

confidence: 99%

Contemporary best practice urolithiasis in pregnancy

Valovska

Pais

2018

Therapeutic Advances in Urology

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Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.

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“…Prior to the use of computed tomography (CT), intravenous urography (IVU) was the imaging modality of choice [ 2 ]. With the development of helical CT scanning, there has been a shift away from the use of labor-intensive and less accurate IVU [ 3 ]. However, a perception exists that much higher radiation doses are being delivered to patients in the era of CT.…”

Section: Introductionmentioning

confidence: 99%

Radiation dosing in the investigation and follow-up of urolithiasis: Comparison between historical and contemporary practices

et al. 2016

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PurposeComputed tomography (CT) is the gold standard imaging modality for the diagnosis and follow-up of urolithiasis. Before the use of CT, intravenous urography (IVU) was the imaging modality of choice. CT remains contentious because of the cancer risk related to radiation exposure above a threshold level. We aimed to compare the radiation exposure dose to the average patient with urolithiasis in the era of CT with that of IVU.Materials and MethodsOur hospital medical records database was searched for patients who presented to the Emergency Department over a 1-month period in 1990 with a diagnosis of renal colic. Patients with the same presentation, from the same month, in 2013 were also identified. A total of 14 patients from each year fulfilled the inclusion criteria. The estimated effective radiation exposure dose for each patient was calculated by using data from population-based studies.ResultsThe median effective radiation dose per patient in the 1990 group, for initial diagnosis and subsequent follow-up, was 4.05 mSv (interquartile range [IQR], 3.7–4.4 mSv). The corresponding median dose in the 2013 group was 4.2 mSv (IQR, 4.2–4.9 mSv), and there was no evidence of a statistical difference between the groups (p=0.8).ConclusionsDespite the contentiousness related to the use of serial CT scanning, our study demonstrated that for radiological investigation and follow-up of urolithiasis, the estimated effective radiation exposure dose to each patient is only marginally higher than in the era of IVU, with improvements in length of hospital stay and time to definitive diagnosis.

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Comparison of Non-contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi

Cited by 11 publications

References 17 publications

Usefulness of Nonenhanced Computed Tomography for Diagnosing Urolithiasis without Pyuria in the Emergency Department

Usefulness of Nonenhanced Computed Tomography for Diagnosing Urolithiasis without Pyuria in the Emergency Department

Contemporary best practice urolithiasis in pregnancy

Radiation dosing in the investigation and follow-up of urolithiasis: Comparison between historical and contemporary practices

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