Renal colic: diagnosis and outcome.

Abstract

To assess whether ultrasonography (US) with or without plain abdominal radiography (kidney, ureter, bladder [KUB] radiography) can replace intravenous urography (IVU) in detection of acute urinary tract obstruction, 101 consecutive patients with renal colic were evaluated with US followed immediately by IVU. Receiver operating characteristic (ROC) curves for US diagnosis of acute urinary tract obstruction yielded sensitivities of 91% and 92% for two reviewers at a specificity of 90%. There was no statistically significant difference between US and IVU results. When US was combined with KUB radiography, ROC curves yielded sensitivities of 94% and 97% for two reviewers at a specificity of 90%.KUB radiography alone was of limited diagnostic value. For US alone, no false-positive results occurred, and the false-negative results (n = 9 and n = 6 for two reviewers) were encountered in cases of grade 1 hydronephrosis and nondilated obstructive uropathy. The authors conclude that US combined with KUB radiography can replace IVU in initial evaluation and follow-up of the great majority of patients with renal colic.

Predicting intervention in renal colic patients after emergency department evaluation

“…Eighteen were admitted from the ED for an intervention, and 32 had their intervention after being discharged from the ED. The urological interventions performed on these patients included ESWL (12 patients), ureteroscopy (27), percutaneous nephrostomy (10), open surgery (1), or more than one procedure (7). In reviewing the operative reports of the patients who underwent an intervention, the reasons cited by the urologists in the charts for performing a procedure on the urinary calculi included: calculus size (32%), development of an infected calculus (19%), severe obstruction (19), location of calculus in the upper ureter (14%), acute renal failure (10%) and persistent pain (6%).…”

“…8,15,[19][20][21][22][23] Our predictive variables for intervention are remarkably similar to other studies 8,12,15,[23][24][25] and demonstrate that our sample of renal colic patients is comparable to other populations described in the literature. 14,[26][27][28] Although not all patients had an intervention or were enrolled in the study, we Not enrolled in study n = 81…”

Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

“…20,21 Thus, unenhanced helical CT is currently the imaging test of choice for evaluating patients with acute fl ank pain for whom the clinical diagnosis is uncertain. [22][23][24][25][26][27][28][29] In the CT evaluation of ureteral calculi, the agreement between the group of senior residents and the consensus among the abdominal radiologists were very good, as shown in Table 3. The interobserver agreement for identifying the ureteral stone was almost perfect (k = 0.81).…”

Renal Colic: Pathophysiology, Diagnosis and Treatment

“…In a study by Haddad et al [8], the clinical diagnosis was accurate in only 70 of 101 patients in whom the kidney problem was the cause of pain. Mutagi et al [9]reported that the sensitivity and specificity of a clinical scoring system based on signs and symptoms was 73 and 46%, respectively, in 85 patients with suspected renal colic.…”

“…The sensitivity of KUB in detecting ureteral calculi ranges from 45 to 59%, thus providing limited value in the diagnosis of ureteral stones [8, 9, 11]. Superimposed bowel and bone obscure some calculi, and vascular calcifications, especially pelvic phleboliths, may be confused with stones.…”