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Plain Computed Tomography of Kidneys, Ureters and Bladder - Report

Added on -2019-09-19

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Plain Computed Tomography of Kidneys, Ureters and Bladder as aFirst Diagnostic Option for Renal Colic Patients in Sohar HospitalAcute Renal Colic: Acute renal colic (ARC) is one of the most common patients symptoms seen in the accident and emergency (A&E) departments and urology clinics worldwide. Renal colic is caused by a urinary stone that affects about 10% to 15% of the population in their lifetime, 50% of these people are predicted to experience a recurrence of urinary stone in the first 10 years after the first incidence (Ahmed et al., 2010; Smith, 2012; Moore et al., 2013; Moore et al., 2014; Lukasiewicz et al., 2014).According to Vijayaraghavan (2009), over 7 million patients were seen in the A&E departments in the United States of America (USA) in 2008 which resulted in an estimated cost of 2.1 Billion dollars. There are approximately 360000 annual visits of ARC in Oman hospitals (Al-Marhoon et al., 2013). Generally, renal stone affects more male than females with a ratio of 3:1. The clinical presentation is usually symptoms of colicky flank pain that irradiates to the groin, and sometimes is associated with hematuria or single sided abdominal pain (Taourel et al., 2008; Sayani et al., 2011; Nadeem et al., 2012; Leveridge et al., 2015). Generally, there are several methods of diagnosing ARC which includes good patient`s history, clinical examination, laboratory investigation and radiological investigation 1
The Role of Imaging in the Assessment of ARC:Various imaging techniques can be used to diagnose renal stones. These include radiography of the kidneys, ureters and bladder (KUB), intravenous urography (IVU), ultrasound (US) and computed tomography of the KUB (CT-KUB).Plain KUB radiography:In the last century plain radiography of the KUB was the initial radiological assessment of ARC. This technique was not so accurate in detecting renal stones due to missing 50% of stones smaller than 5mm in size and their location in the lower portion of the urinary tract system. Also, the stones may be obstructed by faecal matter and gases in the bowel. It has been reported that the sensitivity and specificity of this technique in detecting urinary stone was 18.3% and 77% respectively. However, the radiation burden is very low (0.7mSv) in comparison to IVU (1.5 mSv) and CT (4.7 – 6.5 mSv) which obviously is a benefit as it can be used for follow-up cases (Chuwdhury et al., 2007; Kenniish et al., 2008; Peddu & Desai, 2009; Song et al., 2010).Intravenous urography:Intravenous urography involves the injection of a contrast agent into the anterior cubital vein of the arm to opacify the kidneys and ureters in relation to the surrounding soft tissue structures within the abdomen because the contrast has high atanomic number which make it easily visualized in the x-ray image (Wang et al., 2008; Quirke et al., 2011). Although IVU’s sensitivity and specificity of 59.1% and 94% is higher than for plain KUB radiography, the technique has the following drawbacks; it provides limited information about intra-abdominal pathology, very long examination time, risk of patient 2
reaction to contrast agent such as collapse, itching and vomiting, and special considerations are needed for diabetic patients and those with kidney disease as the contrast agent needs to be excreted from the body to avoid any complications (Kenniishet al., 2008; Lauritsen et al. in 2008; Mccombie et al., 2011).Ultrasound imaging:Ultrasound is basically a device which uses a high frequency sound waves to produce images of the internal structures of the body without the use of ionization radiation (Nicolau et al., 2015). Ultrasound is capable to visualises hydronephrosis which is an indication of obstruction caused by stone, in addition it can identify large urinary stones of 5mm diameter and above. The advantages of US include its portability which means that it can be used at patients’ bed side, wide available, not invasive and it is cheap compared with CT. Its major advantage is the lack of ionizing radiation and its associated hazards (Patatas et al., 2012; Nicolau et al., 2015). On the other hand, US limitations include low detection rate for small stones less than 5mm in size, and inability to provide accurate anatomical location which can lead to misdiagnosis. Its reported sensitivity is 45% and specificity of 88% (Pal and Mellon, 2008; Masselli et al., 2015). It is also operator dependent since the accuracy can be differ from one operator to another in terms of knowledge, experience and skills (Chen et al., 2015). However, US remains the first line of assessing ARC when there is lack of CT equipment or radiologists to interpret the images produced, and also for pregnant women and childrento avoid ionizing radiation risk. It is also recommended when either IVU or MRI is contraindicated (Sayani et al., 2011; Curhan, 2014; Leveridge et al., 2015).3

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