Purpose: To assess the clinical usefulness of color Doppler ultrasound (CDUS) as a diagnostic tool for obstruction of the urinary tract in patients who present to the hospital with acute renal colic.
Methods and Materials: 148 consecutive patients, 65 females and 83 males with ages between 12-81 years (mean 31.7), with unilateral acute flank pain were evaluated with COLOR DOPPLER ULTRASOUND (CDUS). All patients underwent initial evaluation within 6 hours of hospital admission to rule out obstructive ureteral stone. A careful CONVENTIONAL ULTRASONOGRAPHY (US) evaluation of kidney and ureter on the affected side was performed, followed by evaluation and measurement of both ureteric jets (UJ) frequency under transverse CDUS of the bladder. Criteria of abnormality included: unilateral absence of the ureteral jet or diminished jet frequency. We assumed that the contra lateral ureteric jet would make a perfect control since none of the patients had bilateral flank pain. Renal colic CT was performed, selectively in patients whose stones were not identified on initial Ultrasonography.
Results: 91 patients were found to have ureteral stone. In 78 of them, the stone was identified by US, and US failed to diagnose ureteral stone in 13 patients (diagnosis made by CT scan). Ten of the thirteen patients had at least one abnormal sonographic parameter (hydronephrosis or abnormal UJ). Three patients had all parameters considered normal on US. Of the 91 patients with ureteral stones, 76 patients had some degree of hydronephrosis and 84 had abnormal UJ on CDUS (absent in 58, and diminished in 26). In 7, the UJ was considered normal. All 57 patients in whom no stones were found had normal parameters of UJ on the affected side.In our series,the absence of ureteric jet was the most frequent sonographic sign in patient with stones.
Conclusion: We believe that conventional ultrasonography plus ealuation of ureteric jet by CDUS is a very specific and sensitive method to investigate patients with renal colic. It is a fast, non-invasive way to diagnose ureteral stones and to assess the degree of urinary tract obstruction promoted by such a ureteral stone. This non-invasive, cost-effective technique is especially attractive for those working in small community hospital where Spiral CTs are not always available.
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