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Abdel Gawad AM, Moustafa BEA, Abouelgreed TA, Elnady EA, Khater S, Rehan M, Elebiary MF, Fathy BA, Shaalan A, Ramadan N, Hindawy M, Abdelkader SF. Exploring the potential of combined B-mode features and color Doppler ultrasound in the diagnosis of ureteric stone as an alternative to ionizing radiation exposure by computed tomography. Arch Ital Urol Androl 2024; 96:12523. [PMID: 38934522 DOI: 10.4081/aiua.2024.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To assess the diagnostic efficacy of integrating B-mode and color Doppler capabilities of ultrasound (US) to establish a robust standalone diagnostic tool for the diagnosis of ureteric stones as an alternative to non-contrast-enhanced computed tomography (NCCT). METHODS A total of 140 consecutive patients diagnosed with ureteric stones using NCCT were enrolled. On the same day, US in both B-mode and Color Doppler was performed by an experienced radiologist who was blinded to the NCCT scan results. The diagnostic rate of US for stone detection was recorded. Additionally, baseline patient and stone characteristics were analyzed for their association with the accuracy of stone detection using US. RESULTS US exhibited a high sensitivity of 91.43%, detecting 128 out of 140 stone foci. Notably, ureteric stones in the proximal and uretero-vesical junction (UVJ) segments were readily identifiable compared to those in the pelvic region (p = 0.0003). Additionally, hydronephrosis enhanced the US's ability to detect stones (p < 0.0001). Conversely, abdominal gases and obesity adversely affected US capabilities (p < 0.0001 and p = 0.009, respectively). Stone side, size, and density showed no statistically significant impact (p > 0.05). CONCLUSIONS US with its color Doppler capabilities could serve as a reliable and safe alternative imaging modality in the diagnostic work up of patients with ureterolithiasis. Factors including stone location, Hydronephrosis, weight and abdominal gases significantly influenced its accuracy.
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Affiliation(s)
| | | | | | - Esam A Elnady
- Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta.
| | - Saed Khater
- Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta.
| | - Mohamed Rehan
- Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta.
| | | | - Basem A Fathy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ahmed Shaalan
- Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Mohamed Hindawy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Salma F Abdelkader
- Department of Radiology, Faculty of Medicine, Ain shams University, Cairo.
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Leboutte F, Neisius A. [Renal colic]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:551-556. [PMID: 38739159 DOI: 10.1007/s00120-024-02337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Renal colic accounts for 5-10% of all emergency department visits, making it a common condition in acute medicine. The typical clinical presentation is an early indication of urolithiasis. DIAGNOSIS Diagnostic measures include laboratory tests, ultrasound, and low-dose noncontrast computed tomography (CT) scans. Kidney, ureter, bladder (KUB) plain film radiography has been widely replaced by low-dose noncontrast CT with similar radiation dosage. In special patient groups such as children or pregnant women, ionizing radiation should be avoided if possible. TREATMENT General measures involve pain management (non-steroidal anti-inflammatory agents, opioids) and empirical antibiotic treatment for suspected bacterial infection. Depending on the location/size of the stone, pharmacological stone expulsion therapy may be considered. In cases of obstructive pyelonephritis or acute renal insufficiency, early urinary drainage (JJ stent/nephrostomy) is recommended. Definitive stone removal may be performed primarily in some cases (rather small and rather distal ureterolithiasis). It is common to schedule stone removal as a secondary intervention.
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Affiliation(s)
- Francois Leboutte
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
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Kingma RA, Mors R, Bus MTJ, Altobelli E, de Jong IJ, Roemeling S. Cone Beam Computed Tomography-Assisted Percutaneous Nephrolithotomy in a Hybrid Operating Room: Optimization of Patient Selection. J Endourol 2024; 38:432-437. [PMID: 38420888 DOI: 10.1089/end.2023.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Background: Cone beam computed tomography (CBCT) enables intraoperative cross-sectional and three-dimensional imaging of the urinary tract. CBCT in a hybrid operating room can be used for intraoperative detection of residual stones and potential additional stone extraction at the end of percutaneous nephrolithotomy (PCNL). This study describes our initial experience with intraoperative CBCT during PCNL and analyzes its role in potentially improving its outcomes. Methods: We conducted a single-center retrospective cohort study at a tertiary referral hospital between 2018 and 2021. The study aimed to evaluate the outcome of patients who underwent intraoperative noncontrast CBCT scan during PCNL. The CBCT scan was performed when the urologist determined the kidney to be endoscopically stone-free. In case any residual fragments were imaged, an additional effort was made to extract them. Patients were divided into three groups based on treatment outcome: stone-free upon CBCT, not stone-free with additional stone extraction after CBCT, and not stone-free without additional stone extraction. Procedure and patient characteristics were recorded to identify factors associated with additional stone extraction during CBCT-assisted PCNL. Results: A total of 102 procedures were included in this study. Intraoperative CBCT scans showed residual calcifications in 58 (57%) cases. In 39 cases, which is 38% of the total population and 61% of the cases with residual calcifications, one or more residual fragments imaged on the intraoperative CBCT-scan were extracted additionally within the same procedure. A higher Guy's Stone Score was associated with a higher likelihood of additionally extracting stones as a result of the CBCT. Conclusions: CBCT-assisted PCNL in a hybrid operating room can lead to additional stone extraction in the same procedure in 37% of all cases and in over 60% of the cases in which residual fragments are imaged. The value of CBCT-assisted PCNL appears to increase in the case of more complex stone surgery cases.
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Affiliation(s)
- Riemer A Kingma
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Rianne Mors
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Mieke T J Bus
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Emanuela Altobelli
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Stijn Roemeling
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
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Xing Z, Zhu Z, Jiang Z, Zhao J, Chen Q, Xing W, Pan L, Zeng Y, Liu A, Ding J. Automatic Urinary Stone Detection System for Abdominal Non-Enhanced CT Images Reduces the Burden on Radiologists. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:444-454. [PMID: 38343222 PMCID: PMC11031534 DOI: 10.1007/s10278-023-00946-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 04/20/2024]
Abstract
To develop a fully automatic urinary stone detection system (kidney, ureter, and bladder) and to test it in a real clinical environment. The local institutional review board approved this retrospective single-center study that used non-enhanced abdominopelvic CT scans from patients admitted urology (uPatients) and emergency (ePatients). The uPatients were randomly divided into training and validation sets in a ratio of 3:1. We designed a cascade urinary stone map location-feature pyramid networks (USm-FPNs) and innovatively proposed a ureter distance heatmap method to estimate the ureter position on non-enhanced CT to further reduce the false positives. The performances of the system were compared using the free-response receiver operating characteristic curve and the precision-recall curve. This study included 811 uPatients and 356 ePatients. At stone level, the cascade detector USm-FPNs has the mean of false positives per scan (mFP) 1.88 with the sensitivity 0.977 in validation set, and mFP was further reduced to 1.18 with the sensitivity 0.977 after combining the ureter distance heatmap. At patient level, the sensitivity and precision were as high as 0.995 and 0.990 in validation set, respectively. In a real clinical set of ePatients (27.5% of patients contain stones), the mFP was 1.31 with as high as sensitivity 0.977, and the diagnostic time reduced by > 20% with the system help. A fully automatic detection system for entire urinary stones on non-enhanced CT scans was proposed and reduces obviously the burden on junior radiologists without compromising sensitivity in real emergency data.
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Affiliation(s)
- Zhaoyu Xing
- Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Zuhui Zhu
- Department of Radiology, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, China
| | - Zhenxing Jiang
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jingshi Zhao
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qin Chen
- Department of Radiology, People's Hospital of Pengzhou, Chengdu, Sichuan, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yan Zeng
- Department of Research Center, Shanghai United Imaging Intelligence Co. Ltd, Shanghai, China.
| | - Aie Liu
- Department of Research Center, Shanghai United Imaging Intelligence Co. Ltd, Shanghai, China.
| | - Jiule Ding
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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Kingma RA, Doppen C, Bus MTJ, Altobelli E, de Jong IJ, Roemeling S. The significance of clinically insignificant residual fragments after percutaneous nephrolithotomy: an analysis into the relevance of complete stone clearance. World J Urol 2024; 42:78. [PMID: 38353780 PMCID: PMC10866741 DOI: 10.1007/s00345-024-04774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE After treatment for kidney stones, residual fragments with a diameter of ≤ 4 mm are traditionally referred to as 'clinically insignificant residual fragments'. We hypothesize that patients with these fragments are at an increased risk for stone-related morbidity, such as complaints, hydronephrosis, and stone regrowth, when compared to stone-free patients. This study aimed to investigate the relevance of complete stone clearance in surgical treatment of urolithiasis. METHODS We conducted a single-center retrospective cohort study. Patients who underwent percutaneous nephrolithotomy between 2015 and 2020 were included if a CT-scan was available within 6 months after the procedure, and the follow-up duration was at least 1 year. The stone-free status at the end of the first stone episode during the study period was categorized as fully stone-free, not stone-free with small residual fragments (≤ 4 mm) and not stone-free with large residual fragments (> 4 mm). Follow-up data were collected, including stone-related events and re-intervention rates. RESULTS A total of 103 subjects were included with a median follow-up of 21.4 months. Stone-related events occurred in 10 (29.4%) of the fully stone-free subjects, 20 (58.8%) of the subjects with small residual fragments and 25 (71.4%) of the subjects with large residual fragments. The stone-related event-free survival per subgroup resulted in a significantly different survival distribution in a log rank test (p = 0.008). CONCLUSION A complete stone-free status seems to be of fundamental importance for decreasing stone-related morbidity. Further developments and research should focus on optimizing the full clearance of stone material during PCNL.
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Affiliation(s)
- Riemer A Kingma
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Carleen Doppen
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Mieke T J Bus
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Emanuela Altobelli
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Stijn Roemeling
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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Herout R, Putz J, Borkowetz A, Thomas C, Oehlschläger S. Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay. Int Urol Nephrol 2023; 55:3039-3044. [PMID: 37615842 PMCID: PMC10611860 DOI: 10.1007/s11255-023-03749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors. METHODS Billing data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed. RESULTS 2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort. CONCLUSION For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.
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Affiliation(s)
- Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sven Oehlschläger
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Kandasamy M, Chan M, Xiang H, Chan L, Ridley L. Comparison of diagnostic accuracy of ultra low-dose computed tomography and X-ray of the kidneys, ureters and bladder for urolithiasis in the follow-up setting. J Med Imaging Radiat Oncol 2023. [PMID: 37997533 DOI: 10.1111/1754-9485.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Urolithiasis is frequently followed up with a low-dose computed tomography of the kidneys ureters and bladder (LD-CTKUB) with doses typically less than 3 millisieverts. Although X-ray is a lower dose (0.5-1.1 mSv) alternative for follow up, it has lower diagnostic accuracy and is limited to radiopaque calculi. This study aims to compare the diagnostic accuracy of sub-millisievert ultra-low dose CT (ULD-CTKUB) against X-ray KUB for the follow up of urolithiasis when both are compared against the standard of care of a low-dose CT KUB (LD-CTKUB). METHODS This prospective study included patients with a known diagnosis of urolithiasis on prior CTKUB presenting for follow up. Each patient underwent a repeat reference LD-CTKUB, ULD-CTKUB and X-ray KUB. All imaging studies were interpreted by three readers. The radiation dose and quantitative noise was calculated for each CT. Both CT and X-ray were assessed for the presence, number and size of all calculi ≥2 mm. RESULTS A total of 58 patients were included in this study. LD-CTKUB identified 197 calculi. ULD-CTKUB in our study had a mean effective dose of 0.5 mSv compared to X-ray KUB where doses range in the literature from 0.5 to 1.1 mSv. Per-patient pooled analysis for intrarenal calculi when comparing ULD-CTKUB versus X-ray KUB against a reference LD-CTKUB found a sensitivity of 90% versus 67% (P < 0.01) and specificity of 93% versus 98% (P = 0.18) respectively. For ureteric calculi, the sensitivity was 67% versus 33% (P < 0.01) and specificity 94% versus 94% (P = 1.00) respectively. Per-stone pooled analysis detection rate was 79% for ULD-CTKUB versus 48% for X-ray (P < 0.01) when each was compared to the reference LD-CTKUB. Interobserver agreement was high for intrarenal calculi and moderate for ureteric calculi. CONCLUSION Sub-millisievert ULD-CTKUB had lower doses and higher sensitivity than X-ray in patients requiring follow up of known urolithiasis.
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Affiliation(s)
- Mayooran Kandasamy
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Leyendecker P, Roustan FR, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Diagnosis. Prog Urol 2023; 33:782-790. [PMID: 37918979 DOI: 10.1016/j.purol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the stone management and the choice of intervention modality. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the issue was considered in the EAU recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- P Leyendecker
- Service de radiologie B, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, groupe d'imagerie médicale MIM, AFR-SIGU, Strasbourg, France
| | | | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Jeong JY, Cho KS, Kim DH, Jun DY, Moon YJ, Lee JY. A New Parameter for Calcium Oxalate Stones: Impact of Linear Calculus Density on Non-Contrast Computed Tomography. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020267. [PMID: 36837469 PMCID: PMC9962263 DOI: 10.3390/medicina59020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Non-contrast computed tomography (NCCT) is widely used to evaluate urolithiasis. The NCCT attenuation, measured in Hounsfield units (HU), has been evaluated to predict stone characteristics. We propose a novel parameter, linear calculus density (LCD), and analyze variables from NCCT imaging to predict calcium oxalate (CaOx) stones, which are common and challenging to fragment. Materials and Methods: We retrospectively reviewed the medical records of patients with urolithiasis between 2014 and 2017. Among those, 790 patients were included. Based on the NCCT pre-treatment, the maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were obtained. In addition, the variation coefficient of stone density (VCSD = SHI/MSD × 100) and linear calculus density (LCD = VCSD/MSL) were calculated. In accordance with the stone analysis, the patients were divided into two groups (CaOx and non-CaOx groups). The logistic regression model and receiver operating characteristic (ROC) curve were used for predictive modeling. Results: In the CaOx group, the SHI, VCSD, and LCD were more significant than in the non-CaOx group (all p < 0.001). SHI (OR 1.002, 95% CI 1.001-1.004, p < 0.001), VCSD (OR 1.028, 95% CI 1.016-1.041, p < 0.001), and LCD (OR 1.352, 95% CI 1.270-1.444, p < 0.001) were significant independent factors for CaOx stones in the logistic regression models. The areas under the ROC curve for predicting CaOx stones were 0.586 for SHI, 0.66 for VCSD, and 0.739 for LCD, with a cut-point of 2.25. Conclusions: LCD can be a useful new parameter to provide additional information to help discriminate CaOx stones before treatment.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Dae Ho Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-2320; Fax: +82-2-312-2538
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Predictive factors for stone management timing after emergency percutaneous nephrostomy drainage in patients with infection and hydronephrosis secondary to ureteral calculi. Urolithiasis 2022; 51:1. [DOI: 10.1007/s00240-022-01380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
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Caglayan A, Horsanali MO, Kocadurdu K, Ismailoglu E, Guneyli S. Deep learning model-assisted detection of kidney stones on computed tomography. Int Braz J Urol 2022; 48:830-839. [PMID: 35838509 PMCID: PMC9388181 DOI: 10.1590/s1677-5538.ibju.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The aim of this study was to investigate the success of a deep learning model in detecting kidney stones in different planes according to stone size on unenhanced computed tomography (CT) images. Materials and Methods: This retrospective study included 455 patients who underwent CT scanning for kidney stones between January 2016 and January 2020; of them, 405 were diagnosed with kidney stones and 50 were not. Patients with renal stones of 0–1 cm, 1–2 cm, and >2 cm in size were classified into groups 1, 2, and 3, respectively. Two radiologists reviewed 2,959 CT images of 455 patients in three planes. Subsequently, these CT images were evaluated using a deep learning model. The accuracy rate, sensitivity, specificity, and positive and negative predictive values of the deep learning model were determined. Results: The training group accuracy rates of the deep learning model were 98.2%, 99.1%, and 97.3% in the axial plane; 99.1%, 98.2%, and 97.3% in the coronal plane; and 98.2%, 98.2%, and 98.2% in the sagittal plane, respectively. The testing group accuracy rates of the deep learning model were 78%, 68% and 70% in the axial plane; 63%, 72%, and 64% in the coronal plane; and 85%, 89%, and 93% in the sagittal plane, respectively. Conclusions: The use of deep learning algorithms for the detection of kidney stones is reliable and effective. Additionally, these algorithms can reduce the reporting time and cost of CT-dependent urolithiasis detection, leading to early diagnosis and management.
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Affiliation(s)
- Alper Caglayan
- Department of Urology, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Mustafa Ozan Horsanali
- Department of Urology, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Kenan Kocadurdu
- Department of Information Systems, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Eren Ismailoglu
- Deparment of Radiology, Izmir Bakırçay University, Faculty of Medicine, Izmir, Turkey
| | - Serkan Guneyli
- Deparment of Radiology, Izmir Bakırçay University, Faculty of Medicine, Izmir, Turkey
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Tzelves L, Berdempes M, Mourmouris P, Mitsogiannis I, Skolarikos A. Optimal Delivery of Follow-Up Care for the Prevention of Stone Recurrence in Urolithiasis Patients: Improving Outcomes. Res Rep Urol 2022; 14:141-148. [PMID: 35469244 PMCID: PMC9034870 DOI: 10.2147/rru.s277498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022] Open
Abstract
Urolithiasis is a common clinical condition with frequent recurrences. Advances in knowledge of pathophysiological mechanisms permit the categorization of patients to low and high risk for recurrence, with specific metabolic abnormalities diagnosed in the second category. Follow-up is essential for patients with urolithiasis and consists of both imaging and metabolic follow-up with urine studies. No formal guidelines or solid evidence currently exists regarding frequency and type of follow-up studies to be performed in each category. This review aims to summarize existing evidence regarding follow-up, in order to guide clinicians on how and when to follow-up urolithiasis patients according to existing clinical scenario.
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Affiliation(s)
- Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Marinos Berdempes
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Panagiotis Mourmouris
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Iraklis Mitsogiannis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Andreas Skolarikos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
- Correspondence: Andreas Skolarikos, Tel +30 2132058253, Email
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Bourcier JE, Gallard E, Redonnet JP, Abillard M, Billaut Q, Fauque L, Jouanolou A, Garnier D. Ultrasound at the patient's bedside for the diagnosis and prognostication of a renal colic. Ultrasound J 2021; 13:45. [PMID: 34807330 PMCID: PMC8608963 DOI: 10.1186/s13089-021-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Jean-Eudes Bourcier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France. .,Pôle Anesthésie-Réanimation-Urgences, Hôpital de Lourdes, 2 Avenue Alexandre Marqui, 65100, Lourdes, France.
| | - Emeric Gallard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jean-Philippe Redonnet
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Morgan Abillard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Quentin Billaut
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Laura Fauque
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Anna Jouanolou
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Didier Garnier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
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The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.
Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.
Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.
Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.
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Deep learning model for automated kidney stone detection using coronal CT images. Comput Biol Med 2021; 135:104569. [PMID: 34157470 DOI: 10.1016/j.compbiomed.2021.104569] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Kidney stones are a common complaint worldwide, causing many people to admit to emergency rooms with severe pain. Various imaging techniques are used for the diagnosis of kidney stone disease. Specialists are needed for the interpretation and full diagnosis of these images. Computer-aided diagnosis systems are the practical approaches that can be used as auxiliary tools to assist the clinicians in their diagnosis. In this study, an automated detection of kidney stone (having stone/not) using coronal computed tomography (CT) images is proposed with deep learning (DL) technique which has recently made significant progress in the field of artificial intelligence. A total of 1799 images were used by taking different cross-sectional CT images for each person. Our developed automated model showed an accuracy of 96.82% using CT images in detecting the kidney stones. We have observed that our model is able to detect accurately the kidney stones of even small size. Our developed DL model yielded superior results with a larger dataset of 433 subjects and is ready for clinical application. This study shows that recently popular DL methods can be employed to address other challenging problems in urology.
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Doty E, DiGiacomo S, Gunn B, Westafer L, Schoenfeld E. What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review. J Am Coll Emerg Physicians Open 2021; 2:e12446. [PMID: 34179874 PMCID: PMC8208654 DOI: 10.1002/emp2.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Clinicians have minimal guidance regarding the clinical consequences of each radiologic imaging option for suspected renal colic in the emergency department (ED), particularly in relation to patient-centered outcomes. In this scoping review, we sought to identify studies addressing the impact of imaging options on patient-centered aspects of ED renal colic care to help clinicians engage in informed shared decision making. Specifically, we sought to answer questions regarding the effect of obtaining computed tomography (CT; compared with an ultrasound or delayed imaging) on safety outcomes, accuracy, prognosis, and cost (financial and length of stay [LOS]). METHODS We conducted a comprehensive search using Pubmed, EMBASE, Web of Science conference proceedings index, and Google Scholar, identifying studies pertaining to renal colic, urolithiasis, and ureterolithiasis. In a prior qualitative study, stakeholders identified 14 key questions regarding renal colic care in the domains of safety, accuracy, prognosis, and cost. We systematically screened studies and reviewed the full text of articles based on their ability to address the 14 key questions. RESULTS Our search yielded 2570 titles, and 68 met the inclusion criteria. Substantial evidence informed questions regarding test accuracy and radiation exposure, but less evidence was available regarding the effect of imaging modality on patient-oriented outcomes such as cost and prognosis (admissions, ED revisits, and procedures). Reviewed studies demonstrated that both standard renal protocol CT and low-dose CT are highly accurate, with ultrasound having lower accuracy. Several studies found that ureterolithiasis diagnosed by ultrasound was associated with overall reduced radiation exposure. Existing studies did not suggest choice of imaging influences prognosis. Several studies found no substantial differences in monetary cost, but LOS was found to be shorter if a diagnosis was made with point-of-care ultrasound. CONCLUSION There is a plethora of data related to imaging accuracy. However, there is minimal data regarding the effect of CT on many patient-centered outcomes. Further research could improve the patient-centeredness of ED care.
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Affiliation(s)
- Erik Doty
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Stephen DiGiacomo
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Bridget Gunn
- Information and Knowledge Services, Health Sciences Library, Baystate Medical CenterSpringfieldMAUSA
| | - Lauren Westafer
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Elizabeth Schoenfeld
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
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Feasibility of ureter delineation and dose recording in the assessment of ureteric stenosis during brachytherapy for cervical cancer. Brachytherapy 2021; 20:755-764. [PMID: 33926834 DOI: 10.1016/j.brachy.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Ureteric stenosis is the commonest complication to affect the ureter after radiotherapy for cervical cancer; despite this ureters are not contoured as organs at risk and limited dosimetric data exist for them. METHODS/MATERIALS Bilateral ureters were retrospectively delineated on brachytherapy planning imaging for patients treated for cervical cancer between 2014 and 2019. Ureteric stenosis toxicity data and D2cc, D1cc, D0.1cc of the right and left ureter were collated. Ureter V80, V100, V120, and V150 were also analyzed. Univariate analysis was performed to identify predictors of high ureter dose and ureteric stenosis. RESULTS 95 patients were identified and 190 ureters contoured on brachytherapy planning imaging, with a median follow-up duration of 24 months (IQR23.7). 4.2% (4) of patients had grade 3/4 ureteric stenosis. Mean ureter D0.1cc, D1.0cc and D2.0cc on the right were 80.4Gy (±28.9), 56.2Gy (±7.2) and 52.8Gy (±7.6), and on the left were 75.6Gy (±14.6), 54.3Gy (±5.5) and 52.7Gy (±5.5) respectively. Significantly higher ureter doses were present in patients with baseline hydronephrosis (p < 0.002) and interstitial needle use (p = 0.047). Ureters affected by ureteric stenosis received D0.1cc doses between 60-98Gy. 10-14% received point doses in excess of 150% of the prescribed dose (7Gy) with no resulting ureteric stenosis. No significant difference in D0.1cc was found in patients with or without ureteric stenosis. CONCLUSIONS It is feasible to accurately contour ureters on brachytherapy planning imaging. Baseline hydronephrosis and interstitial needle use contribute to higher ureter doses. No association between dose and ureteric stenosis was found.
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Dodig D, Solocki Matić T, Žuža I, Pavlović I, Miletić D, Markić D. Side-by-side evaluation of virtual non-contrast and post-contrast images improves detection of clinically significant urolithiasis on single-phase split bolus dual-energy CT urography. Br J Radiol 2021; 94:20210013. [PMID: 33861140 DOI: 10.1259/bjr.20210013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Studies show insufficient sensitivity of virtual non-contrast (VNC) reconstructions for stone detection in dual-energy CT urography (DE-CTU). The aim of this study was to investigate if side-by-side-evaluation of both VNC and post-contrast images could increase the sensitivity of single-phase split bolus DE-CTU. METHODS Consecutive patients with haematuria who underwent split bolus DE-CTU on the same dual-source DE-CT scanner were retrospectively enrolled in the study. Intravenous furosemide and oral hydration were employed. Two readers, independently and then jointly in two separate sessions, recorded the location and the longest axial stone diameter on three randomised sets of images: separate VNC and post-contrast images, and side-by-side-reconstructions. True non-contrast (TNC) images served as the standard of reference. RESULTS A total of 83 urinary stones were detected on TNC images. Independent reader side-by-side-evaluation of VNC and post-contrast images yielded higher stone detection sensitivity (76 and 84%, respectively) compared to evaluation of only VNC (71 and 81%, respectively) or post-contrast images (64 and 80%, respectively). The sensitivity of joint reader evaluation of side-by-side-images reached almost 86% and was not significantly different from TNC images (p = 0.77). All stones larger than 3 mm were correctly detected by side-by-side-evaluation. Dose reduction of 55% could be achieved by omitting TNC scans. CONCLUSION Side-by-side-VNC and post-contrast image evaluation enable detection of clinically significant urolithiasis on single-phase split bolus DE-CTU with significant dose reduction. ADVANCES IN KNOWLEDGE This study shows that single-phase DE-CTU is feasible if VNC imaging is simultaneously utilised with post-contrast images.
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Affiliation(s)
- Doris Dodig
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Iva Žuža
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Ivan Pavlović
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletić
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Radiology, University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Dean Markić
- Department of Urology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Sen V, Ongun S, Sahin MO, Irer B, Kizer O, Dogan B, Yildiz G. The use of computed tomography as the first imaging modality in patients with renal colic and microscopic haematuria. Int J Clin Pract 2021; 75:e13826. [PMID: 33164270 DOI: 10.1111/ijcp.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the use of computed tomography (CT) as the first imaging modality in patients with renal colic and microscopic haematuria. METHODOLOGY The patients that presented to the emergency service of six health centers with renal colic between January 2017 and January 2018 and were found to have microscopic hematuria on urinalysis were retrospectively evaluated. Only patients for whom non-contrast CT was used as the first imaging modality were included in the study. Patients were divided into two groups according to the stone presence (stone +, stone -) and the groups were compared in terms of demographics and clinical characteristics of patients. RESULTS A total of 834 patients were included in the study and 711 (85.3%) were diagnosed with urolithiasis. CT also revealed additional pathology in 26 (3.1%) patients. The male patients had a significantly higher rate of stones than female patients (89.5% vs 75.2%; P < .001) and the BMI values were also significantly higher in the male patients compared with the females (27.0 ± 2.1 vs 25.0 ± 4.0, P < .001). Right renal colic was more common in female patients and the rate of left renal colic was significantly higher in male patients. The male patients diagnosed with stone disease required treatment at a higher rate than the female patients (P = .005). CONCLUSIONS Because of its high sensitivity and specificity values in the diagnosis of stone disease, easy applicability and fast results, CT can be safely used as the first imaging modality for the diagnosis of renal colic and microscopic haematuria.
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Affiliation(s)
- Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | | | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Onur Kizer
- Department of Urology, Soma State Hospital, Manisa, Turkey
| | - Bayram Dogan
- Department of Urology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Kasi A, Steffens T, Starkey D, Braithwaite V. The proportion of computed tomography kidneys, ureters and bladder (CTKUB) scans that comply with scan extent protocol in an emergency department: a clinical audit and dose ramification study. J Med Radiat Sci 2021; 68:13-20. [PMID: 33350603 PMCID: PMC7890918 DOI: 10.1002/jmrs.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To assess computed tomography kidneys, ureters and bladder (CTKUB) scan extent protocol compliance and associated doses in the Emergency Department (ED) of an Australian tertiary hospital. METHODS A retrospective clinical audit of 150 consecutive ED CTKUB cases was completed. For each patient, scan extent compliance at the superior (kidneys) and inferior (pubic symphysis) borders, in reference to the protocol was recorded. Compliance and non-compliance (over-/under-scanning) was identified, described (superior/inferior), quantified (via IMPAX measurements) and recorded via a purpose-built audit tool. In addition, a PBU40 phantom was scanned to assess the percentage of dose (DLP) increase per centimetre of over-scanning to contextualise results. RESULTS A notable non-compliance with department protocol was noted. Eight cases (5.3%) demonstrated overall CT scan extent compliance. The remaining 142 cases (94.7%) demonstrated some form of non-compliance; superiorly, inferiorly or both. Analysing the 150 superior and 150 inferior data points independently, the most common non-compliance was over-scanning at the kidneys by 4 cm to5 cm (19 cases, ~10% extra DLP) beyond tolerance and over-scanning inferiorly at the pubic symphysis by 1 cm to 2 cm (29 cases, ~6.4% extra DLP). Estimated dose increases of up to 35% to 45% were found when clinical audit results were simulated using a PBU40. CONCLUSIONS Over-scanning is a predominant occurrence in CTKUB scans in this department. Reasons for over-scanning weren't investigated. It's anticipated this audit will lead to greater awareness of scan extent compliance and dose ramifications of non-compliance. The usage of more easily identified anatomical landmarks and a follow-up audit is suggested.
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Affiliation(s)
- Arianne Kasi
- Department of Medical ImagingPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Tom Steffens
- Department of Medical ImagingPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Deborah Starkey
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Vicki Braithwaite
- School of Clinical Sciences, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
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Nestler T. Bildgebung. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ong J, Leonardi M, Espada M, Stamatopoulos N, Georgousopoulou E, Condous G. Ureter Visualization With Transvaginal Ultrasound: A Learning Curve Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2365-2372. [PMID: 32472967 DOI: 10.1002/jum.15345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. METHODS We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. RESULTS A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. CONCLUSIONS Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.
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Affiliation(s)
- Jozarino Ong
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Mathew Leonardi
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Mercedes Espada
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | - Nicole Stamatopoulos
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
| | | | - George Condous
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia
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Almeras C, Denis E, Meria P, Estrade V, Raynal G, Hoznek A, Malval B, Dominique S, Bart S, Gautier JR, Abid N. [Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. Prog Urol 2020; 30:426-429. [PMID: 32389492 PMCID: PMC7198169 DOI: 10.1016/j.purol.2020.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Confrontés à une crise d’une ampleur exceptionnelle liée à la pandémie à coronavirus COVID-19 responsable d’une saturation selon les régions des urgences et des places en réanimation, le Comité Lithiase de l’Association Française d’Urologie (CLAFU) a élaboré pour la première fois les recommandations de prise en charge des calculs urinaires durant cette crise sanitaire.
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Affiliation(s)
- C Almeras
- Urologie, Uro. Sud, RGDS Clinique La Croix du Sud, 52 bis, chemin de Ribaute, 31130 Quint Fonsegrives.
| | - E Denis
- Urologie, Centre hospitalier Saint Joseph Saint Luc, Lyon
| | - P Meria
- Urologie, Hôpital Saint Louis, Paris
| | - V Estrade
- Urologie, Centre hospitalier d'Angoulême, France
| | - G Raynal
- Urologie, Clinique médico- chirurgicale Gaston Métivet, Saint-Maur-des-Fossés
| | - A Hoznek
- Urologie, Hôpital Henri Mondor, Créteil
| | - B Malval
- Urologie, Clinique Saint Hilaire, Rouen
| | - S Dominique
- Urologie, Cabinet d'Urologie Paris Opéra, Paris
| | - S Bart
- Urologie, Centre Hospitalier René Dubos, Pontoise
| | - J R Gautier
- Urologie, Uro. Sud, RGDS Clinique La Croix du Sud, 52 bis, chemin de Ribaute, 31130 Quint Fonsegrives
| | - N Abid
- Urologie, Hospices civils de Lyon, Lyon
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Gadzhiev N, Malkhasyan V, Akopyan G, Petrov S, Jefferson F, Okhunov Z. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications. Asian J Urol 2020; 7:139-148. [PMID: 32257807 PMCID: PMC7096695 DOI: 10.1016/j.ajur.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. Additionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi.
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Affiliation(s)
- Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
- Corresponding author.
| | - Vigen Malkhasyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Gagik Akopyan
- Department of Urology, Sechenov First Moscow State Medical University, Russia
| | - Sergei Petrov
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Oakland, CA, USA
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25
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Very low-dose computerized tomography for confirmation of urinary stone presence. World J Urol 2020; 39:233-238. [PMID: 32124021 DOI: 10.1007/s00345-020-03142-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 02/19/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine whether a modified non-contrast very low-dose computed tomography (VLD-CT) protocol is applicable for confirmation of known urolithiasis. METHODS AND MATERIALS Consecutive adult patients with a CT scan showing urinary tract stone(s) between 6/2017-12/2018 were included. They were referred to a modified VLD-CT protocol if stone presence was equivocal or if stone location needed reassessment before an endourological interventional procedure. The scanned area was limited to the level of initial stone location caudally. Data on patients' demographics andbody mass index, were collected. The scanned length and radiation dose were calculated. Images were reviewed by two radiologists who assessed stone size and location. Follow-up reference standard included stone passage, surgical removal, and other imaging and clinical information. RESULTS Sixty-three patients [63 stones, mean BMI 28.7 (range 19-41.9)] were included. VLD-CTs revealed 31 stones in 31 patients, with a mean stone length of 5.5 mm. Fifteen stones remained at the same location, and 16 had migrated, of which two appeared in the bladder. Thirty-two stones were not observed on VLD-CT. The mean span scanned on the VLD-CT was 274 mm (± 80). The average radiation exposure was 1.47 mGy (range 1.09-3.3), and the absorbed dose was 0.77 mSv (range 0.39-1.43), compared to 10.24 mGy (range 1.75-28.9) and 7.87 mSv (range 1.44-18.5) in the previous scan. The mean radiation dose reduction between scans was 89%. On follow-up, all VLD-CT findings were confirmed. CONCLUSION A modified imaging protocol is applicable for confirmation of stone presence and location by utilizing very low-dose radiation exposure.
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Reggio E, Danilovic A, Tustumi F, Bernardo WM. Urinary lithiasis: diagnostic investigation. Rev Assoc Med Bras (1992) 2019; 65:1037-1041. [PMID: 31531598 DOI: 10.1590/1806-9282.65.8.1037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ernesto Reggio
- . Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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Seitz C, Bach T, Bader M, Berg W, Knoll T, Neisius A, Netsch C, Nothacker M, Schmidt S, Schönthaler M, Siener R, Stein R, Straub M, Strohmaier W, Türk C, Volkmer B. Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025). Urologe A 2019; 58:1304-1312. [DOI: 10.1007/s00120-019-01033-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Die Zunahme des medizinischen Wissens, technische Neuerungen gemeinsam mit demographischem Wandel stellen eine Herausforderung an die Neukonzeption von Leitlinien und klinischen Studien dar. Die vorliegende S2k-Leitlinie, die sich ausschließlich mit Nieren- und Harnleitersteinen beschäftigt, soll die Behandlung von Harnsteinpatienten in Klinik und Praxis unterstützen, aber auch Patienteninformationen zur Urolithiasis geben. Die zunehmende interdisziplinäre Zusammenarbeit in der Steintherapie zeigt sich auch an der Anzahl beteiligter Fachgruppen und Arbeitsgemeinschaften in der Erstellung des neuen Leitlinienupdates. Die vorliegende, aus einem interdisziplinären Konsensusprozess hervorgegangene S2k-Leitlinie stellt die aktuellen Empfehlungen praxisnah dar und gibt Entscheidungshilfen für Diagnostik‑, Therapie- und Metaphylaxemaßnahmen auf Basis von Expertenmeinungen und verfügbaren Evidenzgrundlagen aus der Literatur.
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Increased urinary bladder volume improves the detectability of urinary stones at the ureterovesical junction in non-enhanced computed tomography (NECT). Eur Radiol 2019; 29:6953-6964. [PMID: 31209621 DOI: 10.1007/s00330-019-06279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/08/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the influence of the urinary bladder volume on the detectability of urolithiasis at the ureterovesical junction (UVJ) using a low-dose CT (LD-CT) with iterative reconstruction (IR) and a standard-dose CT (SD-CT) without IR in a large cohort. METHODS Four hundred patients (278 males (69.5%), mean 44.6 ± 14.7 years) with urolithiasis at the UVJ were investigated either by an LD-CT with IR (n = 289, 72%) or an SD-CT without IR (n = 111, 28%) protocol. The detectability of distal urolithiasis was assessed by a dichotomous assessment (definite or questionable) by two radiologists in consensus and by a quantitative analysis of the signal density distribution across a line drawn parallel to the distal ureter. Based on the resulting graph, minimum/maximum density values and mean/maximum upslopes and downslopes were derived and calculated automatically. In all patients, the total bladder volume was calculated by a slice-by-slice approach on axial CT images. RESULTS Patients with definite stones showed significantly higher urinary bladder volumes compared to patients with questionable stones in both LD-CT and SD-CT (p < 0.01). These results were independent of stones' length and patients' BMI values. Using cutoffs of 92 ml for LD-CT and 69 ml for SD-CT, high positive predictive values/accuracy rates of 96%/85% (LD-CT) and 98%/86% (SD-CT) were observed to identify definite urinary stones. CONCLUSIONS Urinary bladder volume has a significant impact on the detectability of distal urolithiasis. Moderate bladder filling by pre-CT hydration with subsequent CT scan at the time of high urge to void increases the detectability of urinary stones at the UVJ in clinical routine. KEY POINTS • Urinary bladder volume significantly affects the detectability of distal urolithiasis • Higher bladder volumes are associated with improved detectability of distal urinary stones • Oral pre-CT hydration for urolithiasis is easily applicable and cost-effective.
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Umbach R, Müller JK, Wendt-Nordahl G, Knoll T, Jessen JP. In-vitro comparison of different slice thicknesses and kernel settings for measurement of urinary stone size by computed tomography. Urolithiasis 2019; 47:583-586. [PMID: 30649576 DOI: 10.1007/s00240-019-01109-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
Non-contrast enhanced computed tomography (NCCT) is widely used measuring stone size in patients with urolithiasis. We performed an evaluation of the accuracy of stone size measuring via NCCT. In an in-vitro study, we analyzed a total of 38 uric acid and 38 phantom stones. Within NCCT, we used different slice thicknesses (1.5 mm, 2.0 mm, and 3.0 mm) and kernel settings (bone and soft-tissue window). Maximal height, maximal length, and maximal width of each stone were measured on a picture archiving and communication system workstation. Blinded to these results, a second physician measured stone size in the same way using a caliper (real stone size). We used the Bland-Altman method for the analysis of agreement between the two measuring methods. The limit of agreement that was deemed clinical insignificant was ± 1.0 mm. All measurements via NCCT correlated significantly with the real stone size (p < 0.001). This was more pronounced for bone window and smaller slice thickness. Bland-Altman plots showed limits of agreement that exceeded the a priori defined level for all types of measurement with bone window and small slice thickness (1.5 mm) being better than soft-tissue window and large slice thickness (3.0 mm). We conclude that stone size measurement by NCCT with established settings is not exact. Stone size can easily be over- or underestimated by several millimeters. Using bone window and small slice thickness leads to more accurate results.
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Affiliation(s)
- Roland Umbach
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany.
| | - Jochen-Klaus Müller
- Department of Radiology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Sindelfingen, Germany
| | - Gunnar Wendt-Nordahl
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
| | - Thomas Knoll
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
| | - Jan Peter Jessen
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
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Keoghane S, Austin T, Coode-Bate J, Deverill S, Drake T, Sanpera-Iglesias J, Johnston T. The diagnostic yield of computed tomography in the management of acute flank pain and the emergency intervention rate for a proven acute ureteric stone. Ann R Coll Surg Engl 2018; 100:1-8. [PMID: 30286646 PMCID: PMC6204509 DOI: 10.1308/rcsann.2018.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The diagnostic and management pathways for patients presenting with acute flank pain are complex. Although computed tomography (CT) of the kidneys, ureters and bladder (KUB) is the gold standard investigation for urolithiasis, the multitude of differential diagnoses must also be considered in the context of long-term risk from ionising radiation. This study investigated the integrated role and diagnostic yield of non-contrast CT in cases of acute flank pain. METHODS A retrospective cohort study was undertaken of 1,442 consecutive patients investigated with CT KUB between March 2013 and February 2015. The primary outcome was diagnostic yield of CT with secondary outcomes being predictors of need for urological intervention. RESULTS A cause for acute flank pain was identified in 717 patients (50%), there was an incidental finding in 389 patients (27%) and normal imaging was reported in 336 patients (23%). A diagnosis was more commonly made in male than in female patients (70% vs 40%) and with increasing age (46% in patients aged <30 years, 56% in those aged 30-49 years and 63% in those aged ≥50 years). The overall rate for an ipsilateral urinary tract stone was 41%. Factors strongly associated with emergency intervention included stone size >10mm (odds ratio [OR]: 11.7, 95% confidence interval [CI]: 3.3-42.7), stones located at the pelviureteric junction (OR: 7.8, 95% CI: 2.6-22.9), C-reactive protein >50mg/l and ≤100mg/l (OR: 15.2, 95% CI: 5.1-45.3), and estimated glomerular filtration rate ≤30ml/min (OR: 5.8, 95% CI: 1.5-21.8). CONCLUSIONS This contemporary study identifies age and sex as independent variables affecting the diagnostic yield of CT KUB in cases of acute flank pain, and highlights factors associated with a need for emergency intervention in proven ureteric stones.
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Affiliation(s)
- S Keoghane
- West Suffolk NHS Foundation Trust, UK
- Portsmouth Hospitals NHS Trust, UK
| | - T Austin
- Portsmouth Hospitals NHS Trust, UK
| | | | | | - T Drake
- Portsmouth Hospitals NHS Trust, UK
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Wollin DA, Gupta RT, Young B, Cone E, Kaplan A, Marin D, Patel BN, Mazurowski MA, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi? Urology 2018; 120:56-61. [PMID: 30006268 DOI: 10.1016/j.urology.2018.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation. MATERIALS AND METHODS Seven fresh tissue cadavers were implanted with stones of known size and/or composition and imaged with KUB, DT, and NCCT. Four blinded readers (2 urologists, 2 radiologists) evaluated KUBs for presence and/or location of calculi. They then re-evaluated with addition of tomograms to assess additional value. After a memory extinction period, readers evaluated NCCT images. Accuracy of detection was determined using nearest-neighbor match with generalized linear mixed modeling. RESULTS Total of 59 stones were identified on reference read. Overall, NCCT and DT were both superior to KUB alone (P < .001) while the difference between DT and NCCT was not significant (P = .06). When evaluating uric acid stones, NCCT and DT outperformed KUB (P < .01 and P < .05, respectively) while DT and NCCT were similar (P = .16). Intrarenal stones were better evaluated on DT and NCCT (P < .001 compared to KUB), while DT and NCCT were similar (P = 1.00). Accuracy was lower than anticipated across modalities due to use of the cadaver model. CONCLUSION Our study demonstrates DT is superior to KUB for identification of intrarenal calculi and could replace routine use of KUB or NCCT for detecting renal stones, even those composed of uric acid.
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Affiliation(s)
- Daniel A Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Rajan T Gupta
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC; Department of Radiology, Duke University Medical Center, Durham, NC
| | - Brian Young
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Eugene Cone
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Adam Kaplan
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Bhavik N Patel
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiology, Stanford University, Palo Alto, CA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
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Rodger F, Roditi G, Aboumarzouk O. Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review. Urol Int 2018; 100:375-385. [DOI: 10.1159/000488062] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/01/2018] [Indexed: 12/27/2022]
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Sade R, Ogul H, Eren S, Levent A, Kantarci M. Comparison of Ultrasonography and Low-Dose Computed Tomography for the Diagnosis of Pediatric Urolithiasis in the Emergency Department. Eurasian J Med 2017. [PMID: 28638256 DOI: 10.5152/eurasianjmed.2017.17083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to compare ultrasonography (US) and low-dose computed tomography (LDCT) for diagnosing pediatric urolithiasis in the emergency department. MATERIALS AND METHODS This retrospective study was approved by our institutional ethics committee, and informed consent was waived. From March 2016 to March 2017, 100 consecutive patients met the selection criteria and were enrolled in the study. Patients were randomly selected in a 1:1 ratio and were allocated to one of the following two imaging groups: US or abdominal LDCT. LDCT examinations were performed using a 320-detector row CT. Radiation dose analysis was performed using Radimetrics. US examinations were performed using the Aplio 500 ultrasound system. The presence of urolithiasis, anatomical location of urolithiasis, and measurements of renal stones were evaluated and recorded. RESULTS There were statistically significant differences between US and standard-dose CT (SDCT) with respect to the diagnosis of urolithiasis, anatomical location of urolithiasis, and measurements of renal stones (p<0.001, p=0.005, and p=0.03, respectively). The mean effective radiation dose of LDCT was 1.44±0.34 mSv and that of SDCT was calculated to be 4.36±1.33 mSv. There was no statistically significant difference between LDCT and SDCT with regard to the diagnosis of urolithiasis, anatomical location of urolithiasis and measurements of renal stones (p=1 for all). The diagnostic accuracy of US and LDCT was 0.68 and 1.0, respectively. CONCLUSION Low-dose computed tomography had 1/3 SDCT radiation dose, and LDCT and SDCT accurately diagnosed pediatric urolithiasis in the emergency department. US had a lower accuracy than SDCT and LDCT for diagnosing pediatric urolithiasis in the emergency department. LDCT can be an alternative for SDCT for diagnosing pediatric urolithiasis.
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Affiliation(s)
- Recep Sade
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Suat Eren
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Akin Levent
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
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