Is limited non-contrast pelvic CT really indicated for asymptomatic patients with small distal ureteric calculi?
Author(s):
Miss Natalie Hicks
,
Miss Natalie Hicks
Affiliations:
Mr Neil Burgess
Mr Neil Burgess
Affiliations:
BAUS ePoster online library. Hicks N. 06/26/17; 177356; P2-10
Ms. Natalie Hicks
Ms. Natalie Hicks
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Abstract
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Introduction

Our objective was to investigate whether patients with asymptomatic small distal ureteric calculi require follow-up imaging to confirm stone passage.

Patients and Methods

Patients were identified from a prospective database of all new cases of urolithiasis presenting at a UK teaching hospital in 2015. Those who had a computer-tomography (CT) confirmed calculus in the distal ureter of 5mm or less were included.

Results

594 cases were added to our database in 2015, of which 122 met study inclusion criteria. 108 patients were managed conservatively. Of these 92 attended for follow-up at a mean of 5.1 weeks (SD=2.38).

At follow-up 73 patients had no evidence of stone passage. Of the 16 symptomatic patients, the majority (n=14) had follow-up CT. Persistent calculus was demonstrated on two. The remaining two patients had radiographs; one showed a calculus.

57 patients were asymptomatic at follow-up. 39 patients with no evidence of stone passage or symptoms underwent a limited non-contrast pelvic CT. Four (10.3%) had not passed the calculus. The mean time between initial and follow-up CT was 11.4 weeks (SD=7.70). Fourteen cases had no further imaging, none have re-presented. The remaining patients had ultrasound (n=2) or radiograph (n=2) follow up.

Conclusion

In this limited study, although numbers are small, the detection rate of 10% is important when considering follow-up in asymptomatic patients with small distal ureteric calculi . When the drawbacks of repeated imaging are weighed against the risks of undetected calculi it would appear from these results that we remain reliant on CT.
Introduction

Our objective was to investigate whether patients with asymptomatic small distal ureteric calculi require follow-up imaging to confirm stone passage.

Patients and Methods

Patients were identified from a prospective database of all new cases of urolithiasis presenting at a UK teaching hospital in 2015. Those who had a computer-tomography (CT) confirmed calculus in the distal ureter of 5mm or less were included.

Results

594 cases were added to our database in 2015, of which 122 met study inclusion criteria. 108 patients were managed conservatively. Of these 92 attended for follow-up at a mean of 5.1 weeks (SD=2.38).

At follow-up 73 patients had no evidence of stone passage. Of the 16 symptomatic patients, the majority (n=14) had follow-up CT. Persistent calculus was demonstrated on two. The remaining two patients had radiographs; one showed a calculus.

57 patients were asymptomatic at follow-up. 39 patients with no evidence of stone passage or symptoms underwent a limited non-contrast pelvic CT. Four (10.3%) had not passed the calculus. The mean time between initial and follow-up CT was 11.4 weeks (SD=7.70). Fourteen cases had no further imaging, none have re-presented. The remaining patients had ultrasound (n=2) or radiograph (n=2) follow up.

Conclusion

In this limited study, although numbers are small, the detection rate of 10% is important when considering follow-up in asymptomatic patients with small distal ureteric calculi . When the drawbacks of repeated imaging are weighed against the risks of undetected calculi it would appear from these results that we remain reliant on CT.
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