DIAGNOSTIC VALUE OF NON-CONTRAST HELICAL CT-SCAN AND INTRAVENOUS UROGRAPHY IN UROLITHIASIS EVALUATION

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Published 2015-04-01
Fadhli Hasan Doddy M Soebadi Sunaryo Hardjowijoto Mohamad Ayodhia Soebadi Triyono Karmawan Sukmana Pria Widodo J Pudjirahardjo

Abstract

Objective: To evaluate the diagnostic value of Non Contrast Helical Computed Tomography (NCHCT) scanning as the first choice diagnostic modality for detecting urolithiasis cases in Soetomo General Hospital Surabaya and evaluate the feasibility as alternative to Intravenous Urography (IVU). Material & Methods: Seventeen patients with clinical manifestation of suspected urolithiasis underwent NCHCT and IVU to evaluate suspected urolithiasis. Reformatted three-dimensional CT was performed in all patients. The images were correlated with findings from surgical procedure (ureteroscopy, percutaneous nephrolithotomy, and open surgery). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined for NCHCT and IVU. Results: The diagnosis of urolithiasis was defined as unequivocal evidence of urolithiasis on either NCHCT or IVU. Sixteen of seventeen patients evaluated were diagnosed with urolithiasis. NCHCT established the diagnosis in 16 of 17 patients while IVU was positive in 11 of 17 patients. IVU was negative in 6 of the 17 cases. The sensitivity, specificity and accuracy of NCHCT was 100%, 100%, and 100% respectively (p = 0.05) and the sensitivity, specificity, and accuracy of IVU was 68%, 100% and 70% respectively (p = 0.35). There was no statistically significant difference between IVU and NCHCT using Fisher’s exact test. Conclusions: NCHCT accurately diagnosed urolithiasis in patients with suspected urolithiasis. Considering that NCHCT is more effective and efficient than IVU as diagnostic modality in determining the presence of urolithiasis, it may be considered to replace IVU as the first line diagnostic tool for urolithiasis in Soetomo General Hospital Surabaya. Keywords: Non Contrast Helical CT Scan, Intravenous Urography, Urolithiasis.


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References

Margaret S, Pearle, Yair Lotan. Urinary lithiasis: Etiology, epidemiology, and pathogenesis. Wein AJ et al (eds). In: Campbell-Walls Urology 10th ed. Saunders Elsevier; Philadelphia. 2012; 45: 1257-59.

Stoller ML. Urinary stone disease. Tanagho EA, McAninch JW (eds). In: Smith’s General Urology, 17th edition. McGraw-Hill; New York. 2008; 16: 246-27.

Romero V, Akpinar H, Assimos DG. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010; 12(2-3): e86-e96.

Statistik Rumah Sakit di Indonesia. Seri 3. Morbiditas dan mortalitas. Direktorat Jenderal Pelayanan Medik. Departemen Kesehatan RI; 2004.

Sumardi Rochani, Taher Akmal, Mochtar CA, Rasyid N, Tarmono, Safriadi F, et al. Guidelines penatalaksanaanpenyakit batu saluran kemih 2007. Ikatan Ahli Urologi Indonesia; 2007. p. 1-3.

Laporan Tahunan Tahun 2007 Departemen Urologi, RSU Dr. Soetomo-Fakultas Kedokteran Universitas Airlangga, Surabaya; 2007.

Munver R, Preminger JM. Urinary tract stone, in: Weis RM, George NJR, O’Reilly PH: Comprehensive Urology. Mosby International Limited: London; 2001. p. 313-23.

Svedstrom E, Alanen A, Nurmi M. Radiologic diagnosis of renal colic: The role of plain film, excretory urography, and sonography. Elsevier. Eur Radiol; 1990. p. 180-3.

Miller OF, Rineer SK, Scott R Richard, Robert G Buckley, Murray S Donovan, Ian R Graham, et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urography in the evaluation of acute renal colic. Elsevier. Journal of Urology; 1998. p. 982-7.

Michael Y, Chen M, Zagoria RJ. Cannon contrast helical computed tomography replace intravenous urography for evaluation of patient with acute urinary tract calculi? Elsevier. Journal of Emergency Medicine.1999; 17(2); 299-303.

Jia Hwia Wang, Shu Huei Shen, Shan Su Huang, Cheng Yen Chang. Prospective comparison of unenhanced spiral computed tomography and intravenous urography in the evaluation of acute renal colic. Original Article. Chin Med Assoc. January 2008; 71(1).

Ronald J Zagoria. Helical CT of urolithiasis: Leaving no stone unturned. Applied Radiology. Anderson Publishing Ltd, Ocean, NJ; 1998.

Crompton G, Cossom P. A Systemic review comparing the appropriateness of the intravenous urogram and the computed tomography urogram in term of diagnostic accuracy and risk of radiation dose for patient with urolithiasis. Elsevier. Journal of Radiology. 2011; 17: 304-10.

Hammad AM, Kulsoom F. Alternate and insidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain. Department of Surgery Aga Khan University, Karachi, Pakistan. Urology Journal; 2009: 6(1).

Franco A, Tomas M, Burgos AA. Intravenous urography is dead. Long Live Computerized Tomography. Elsevier Espana. Actas Urologicas Espanolas; 2010. p. 764-74.

SV Bariol SA Moussa, DA Tolley. Contemporary imaging for management of urinary stones. EAU Update Series, Elsevier. Journal of Urology; 2004.

Saita H, Matsukawa M, Fukushima H. Ultrasound diagnosis of ureteral stones: Its usefulness with subsequent excretory urography. Elsevier. J Urol. 1987; 140; 28-31.

Siclair D, Wilson S, Toi A. The evaluation of suspected renal colic: Ultrasound scan excretory urography. Ann Emerg Med. 1989; 18: 556-9.

Lanmark, Beaconsfield, Bucks. President’s conference paper: CT scanning the early days. United Kingdom. The British Journal of Radiology. 2006; 79: 5-8.

What is CT stonogram? Healthcare-Philips, 2012. www.nursedirectory.net/challenge.

Thomas G Dehn. Ionizing radiation exposure from radiologic imaging: The issue and what we can do. A Magellan Health Company akses melalui www.NIAhealthcare.com, National Imaging Associates; 2007.

Franco A, Tomas M, Burgos AA. Intravenous urography is dead. Long Live Computerized Tomography. Elsevier Espana. Actas Urologicas Espanolas; 2010. p. 764-74.

Manoucher S. Intravenous radiocontrast media: A review of allergic reactions. Department of Pharmacy, Alta Bates Summit Medical Centre: Barkeley, California, US Pharm. 2012; 37: 14-6.

Jagdish Singh, Aditya Daftary. Iodinated contrast media and their adverse reactions. Teleradiology Solutions: Bangalore, India; 2007.

Smith JK, Eugene C Lind, Mark E Lockhart. Urinary calculi imaging. Medscapes. Agustus 2011. www.emedicine. medscape.com/article/381993.

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Department of Urology, Faculty of Medicine/Airlangga University