Unenhanced helical CT of ureteral stones: A replacement for excretory urography in planning treatment

Julia R. Fielding, Stuart G. Silverman, Salim Samuel, Kelly H. Zou, Kevin R. Loughlin

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to determine whether unenhanced helical CT alone can be used for diagnosis and treatment planning of patients with obstructing ureteral stones. MATERIALS AND METHODS. Medical records of 100 patients with ureteral stones and a clearly discernible clinical outcome who had undergone unenhanced helical CT were reviewed to determine the number of urography procedures and results of excretory urograms performed within 72 hr of helical CT. CT scans were then reviewed by two radiologists for six findings: in-plane stone diameter, z-axis stone diameter, location of stone, periureteral stranding, hydronephrosis, and perinephric fluid. Seventy-one patients passed stones spontaneously, and 29 patients required intervention including basket retrieval, extracorporeal shock-wave lithotripsy, laser lithotripsy, or a combination of the three treatments. Data were analyzed to determine those findings that correlated with the need for intervention. RESULTS. Five excretory urograms were obtained, all of which agreed with findings revealed by CT. Excretory urography added no information. CT findings of in-plane diameter (p < .001), z-axis diameter (p < .001), and location of stone (p = .003) all significantly correlated with the need for intervention. CONCLUSION. Helical CT can be used in place of excretory urography to plan treatment of patients with flank pain caused by obstructing ureteral stones. Stones that are larger than 5 mm, located within the proximal two thirds of the ureter, and seen on two or more consecutive CT images are more likely to require endoscopic removal, lithotripsy, or both.

Original languageEnglish (US)
Pages (from-to)1051-1053
Number of pages3
JournalAmerican Journal of Roentgenology
Volume171
Issue number4
DOIs
StatePublished - Jan 1 1998

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Urography
Spiral Computed Tomography
Lithotripsy
Laser Lithotripsy
Flank Pain
Therapeutics
Hydronephrosis
Ureter
Medical Records
Shock

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Unenhanced helical CT of ureteral stones : A replacement for excretory urography in planning treatment. / Fielding, Julia R.; Silverman, Stuart G.; Samuel, Salim; Zou, Kelly H.; Loughlin, Kevin R.

In: American Journal of Roentgenology, Vol. 171, No. 4, 01.01.1998, p. 1051-1053.

Research output: Contribution to journalArticle

Fielding, Julia R. ; Silverman, Stuart G. ; Samuel, Salim ; Zou, Kelly H. ; Loughlin, Kevin R. / Unenhanced helical CT of ureteral stones : A replacement for excretory urography in planning treatment. In: American Journal of Roentgenology. 1998 ; Vol. 171, No. 4. pp. 1051-1053.
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N2 - OBJECTIVE. The purpose of this study was to determine whether unenhanced helical CT alone can be used for diagnosis and treatment planning of patients with obstructing ureteral stones. MATERIALS AND METHODS. Medical records of 100 patients with ureteral stones and a clearly discernible clinical outcome who had undergone unenhanced helical CT were reviewed to determine the number of urography procedures and results of excretory urograms performed within 72 hr of helical CT. CT scans were then reviewed by two radiologists for six findings: in-plane stone diameter, z-axis stone diameter, location of stone, periureteral stranding, hydronephrosis, and perinephric fluid. Seventy-one patients passed stones spontaneously, and 29 patients required intervention including basket retrieval, extracorporeal shock-wave lithotripsy, laser lithotripsy, or a combination of the three treatments. Data were analyzed to determine those findings that correlated with the need for intervention. RESULTS. Five excretory urograms were obtained, all of which agreed with findings revealed by CT. Excretory urography added no information. CT findings of in-plane diameter (p < .001), z-axis diameter (p < .001), and location of stone (p = .003) all significantly correlated with the need for intervention. CONCLUSION. Helical CT can be used in place of excretory urography to plan treatment of patients with flank pain caused by obstructing ureteral stones. Stones that are larger than 5 mm, located within the proximal two thirds of the ureter, and seen on two or more consecutive CT images are more likely to require endoscopic removal, lithotripsy, or both.

AB - OBJECTIVE. The purpose of this study was to determine whether unenhanced helical CT alone can be used for diagnosis and treatment planning of patients with obstructing ureteral stones. MATERIALS AND METHODS. Medical records of 100 patients with ureteral stones and a clearly discernible clinical outcome who had undergone unenhanced helical CT were reviewed to determine the number of urography procedures and results of excretory urograms performed within 72 hr of helical CT. CT scans were then reviewed by two radiologists for six findings: in-plane stone diameter, z-axis stone diameter, location of stone, periureteral stranding, hydronephrosis, and perinephric fluid. Seventy-one patients passed stones spontaneously, and 29 patients required intervention including basket retrieval, extracorporeal shock-wave lithotripsy, laser lithotripsy, or a combination of the three treatments. Data were analyzed to determine those findings that correlated with the need for intervention. RESULTS. Five excretory urograms were obtained, all of which agreed with findings revealed by CT. Excretory urography added no information. CT findings of in-plane diameter (p < .001), z-axis diameter (p < .001), and location of stone (p = .003) all significantly correlated with the need for intervention. CONCLUSION. Helical CT can be used in place of excretory urography to plan treatment of patients with flank pain caused by obstructing ureteral stones. Stones that are larger than 5 mm, located within the proximal two thirds of the ureter, and seen on two or more consecutive CT images are more likely to require endoscopic removal, lithotripsy, or both.

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