Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Aug;85(1016):1118-22.
doi: 10.1259/bjr/62994625. Epub 2012 Apr 11.

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

K Patatas  1 , N Panditaratne, T M Wah, M J Weston, H C Irving
Affiliations

Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service

K Patatas et al. Br J Radiol. 2012 Aug.

Abstract

Objectives: The objective of our study is to determine the positive rate for urolithiasis in male and female patients, and evaluate whether there has been any change at our institution in the use and outcome of unenhanced multidetector CT (CT KUB) performed in the emergency department (ER) for patients presenting with suspected acute renal colic.

Methods: A retrospective review of all 1357 consecutive cases between August 2007 and August 2009 admitted to the ER and investigated with CT KUB.

Results: The positive rate for urolithiasis was 47.5% and the rate of other significant findings was 10%. Female patients had a significantly lower positive rate than male patients (26.8% vs 61.6%, p<0.001). Urological intervention was required in 37% and these patients had a larger average stone size. In young female patients with a significantly sized ureteric calculus (>4 mm), the presence of hydronephrosis vs no hydronephrosis was 83% vs 17%, respectively. Among them, only three patients required ureteroscopy for stone removal.

Conclusion: Contrary to other studies there has been no "indication creep" in the use of CT KUB at our institution. However, the young female patient presenting with suspected urolithiasis presents a particular diagnostic problem, and the significant percentage of negative examinations in females implies that an improvement in current practice is needed. The indiscriminate use of CT KUB in all female patients with flank pain should be avoided, and it is suggested that they should be initially evaluated with ultrasound to detect the presence of hydronephrosis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The management pathway for patients with suspected acute renal colic at our institution. AAA, abdominal aortic aneurysm; CDU, clinical decisions unit; CT KUB, unenhanced multidetector CT; UTI, urinary tract infection.
See this image and copyright information in PMC

References

    1. Kirpalani A, Khalili K, Lee S. Renal colic: comparison of use and outcomes of unenhanced helical CT for emergency investigation in 1998 and 2002. Radiology 2005;236:554–8 - PubMed
    1. Kennish SJ, Bhatnagar P, Wah TM, Bush S, Irving HC. Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era? Clinical Radiology 2008;63:1131–5 - PubMed
    1. Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol 2002;41:351–62 - PubMed
    1. Dalrymple NC, Verga M, Anderson KR, Bove P, Covey AM, Rosenfield AT, et al. The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol 1998;159:735–40 - PubMed
    1. Katz DS, Lane MJ, Sommer FG. Non-contrast spiral CT for patients with suspected renal colic. Eur Radiol 1997;7:680–5 - PubMed

MeSH terms