Ultrasound at the patient’s bedside for the diagnosis and prognostication of a renal colic

Abstract

Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p < 0.01). Conversely, distal ureteral stones with a diameter of < 6 mm were managed with medical ambulatory treatment (p < 0.05). Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.

Point-of-Care Ultrasound by Emergency Physicians for Ureteral Stone Detection: A Case Series and Review of the Literature

“…To our knowledge, only one small, prospective, recently published study investigated the use of POCUS by EPs to directly identify obstructive ureteral stones. Bourcier et al [ 10 ] demonstrated in a group of 103 patients that, while EPs had an accuracy of POCUS of 91% for detecting urinary tract dilatation, they had only a 54% accuracy for directly detecting kidney stones. Along with study strengths, such as the methodologic design, there are a few limitations, including a relatively small population from a single small emergency unit (19,000 visits per year) as well as highly demanding criteria for POCUS performers, including a 5-day theoretical and practical training course at a certified center along with 18 months of follow-up e-learning.…”

“…Unfortunately, a comprehensive meta-analysis showed that hydronephrosis is neither sensitive nor specific as an indicator for nephrolithiasis [ 9 ]. There is a paucity of literature on the use of POCUS by emergency physicians (EPs) to directly identify obstructive ureteral stones [ 10 ].…”

The Systematic Review of Radiologic Imaging in Suspected Renal Colic

“…Bourcier, et al (2021) 9 showed that the performance of PoCUS in detecting lithiasis, and therefore ureteral colic was as follow: accuracy, 54%; sensitivity, 43%; and specificity, 92%. Among the 85 patients diagnosed with ureteral colic, 43 had lithiasis not detected on ultrasound (14 in the bladder-ureteral junction, six in the pelvic ureter, 21 in the lumbar ureter, and two in the proximal ureter).…”

“…These measures did not improve appreciably for patients with confirmed stone or signs of recent stone passage on formal imaging (sensitivity 78. 9 showed that eight patients diagnosed with renal colic had no ureteral lithiasis on CT, but had pyelocalyceal cavity dilatation. Six of them had bladder lithiasis and two had spontaneous elimination of stones between the PoCUS and CT examinations.…”

A Review on Kidney Stones & A Patient Satisfaction Survey of an Ayurvedic Brand to Treat Kidney Stones

“…Thiazide diuretics are the most efficient and welltested diuretic medications, and they are successfully utilized for calcium stones. Example: Hydrochlorothiazide 20,21 . • Expulsive therapy: The expulsive method of treating kidney stones includes the use of medications to aid the naturally occurring transit of ureteral calculi.…”