Ultrasound for renal colic

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Sorin on Oct 09, 2010 Says :

Excellent work, dear Prof Tuma!

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Ultrasound in renal colic Ass.Prof. Dr. med. Jan Tuma, Dr.med.H.R.Schwarzenbach Switzerland

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Is US in renal colic still necessary? Still: It was useful, but not any more? Something much better is existing? It is not necessary, because almost small stones are coming spontaneously… Ultrasound was poor investigation all the time It was poor, now we have much better method…

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How good is US, IVP and CT? J.M.H. Teichmann: Acute renal colic from ureteral calculus. NEJM 350: 684-693 (2004): Sensitivity: IVP 87% US11-24% CT96%

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Big Differencies in Ultrasound-Studies: Sensitivity Ureteral Stones: 0.7-98.2 % Why? Different, partly old Equipment? Our Study 1986: Toshiba SAL 20/35 Sensitivity 81% Poor Investigation Technique Mutazindwa(Saud Arab) founded 1 from 140 Stones… If ultrasound, then properly…

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How good is US, IVP and CT? Results of CT-Studies without contrast are for stones better than IVP, US and MRI. In ultrasound studies it is necessary to work with the adequate investigation technique, than are the results much better, as often presented

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Exact Training Program is necesarry SSUM- Principles: urologists and radiologists have ultrasound integrated in postgradued training program… All others must absolve structured ultrasound training with basic/advance and closing course and make 500 ultrasound examination, 200 of them under supervision of official SSUM-teachers.

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Special investigation technique Basic Examination Twinkling Urin-Jet RI-Difference of renal parenchymal arteries

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Basic Examination Side-oblique position of patient: pyelon pyelo-ureteral junction

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Basic Examination Side-oblique of patient: pyelo-ureteral junction Supine position of patient: crossing ureter and iliacal vessels ureter-bladder junction

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Basic Examination Side-oblique position of patient: pyelo-ureteral junction Supine position of patient: crossing ureter and iliacal vessels ureter-bladder junction Abdominal position of patient: pyelo-ureteral junction RI renal parenchymal vessels

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Stone: Twinkling

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Stone

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Special investigation technique Basic Examination Twinkling

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Twinkling

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Twinkling

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Stone

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Special investigation technique Basic examination Twinkling Urine-Jet Normal: 10 ± 5 jets / 5 min (both sides) Renal colic: < 2 jets on colic side and > 5 on the other side

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34 Urine-Jet

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35 Urine-Jet

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36 Urine-Jet

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37 Urine-Jet

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38 Urine-Jet

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39 Urine-Jet

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40 Urine-Jet after 5 Min:

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41 Urine-Jet

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Urine-Jet and Twinkling

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Special investigation technique Basic Examination Twinkling Jet RI-Difference of renal parenchymal Arteries

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Special investigation technique Basic examination Twinkling Urine-Jet RI-Difference of renal parenchymal arteries ?RI > 0.05-0.10 and higher on colic side

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Indirect Signs of ureteral Stones Hematuria Obstruction RI-Difference Jet-Difference

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Hematuria (65-95%)

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Indirect Signs of ureteral Stones Hematuria Obstruction Ureter > 5 mm in 2 cm Distance of P-U-Junction

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Obstruction Grade 2

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Obstruction Grade 3

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Obstruction Grade 3

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Obstruction Grade 3

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Obstruction Grade 4

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Indirect Signs of ureteral Stones Hematuria Obstruction Ureter > 5 mm in 2 cm Distance of P-U-Junction RI-Difference of renal parenchymal arteries ?RI > 0.05-0.10 and higher on colic side

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Renal colic right

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Renal colic right RI right 0.78 RI left 0.63 ? RI 0.15

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60 Prospective Study Tuma J, Schwarzenbach HR. Ultraschall bei Nierenkolik. Schweiz Rundsch Med Prax 2004 October 20;93(43):1767-74. 60

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Results 70 Patients with renal colic 54 ureteral stones 35 spontaneous passage 09 Lithotrypsy 10 other urologic interventions 16 Other Diagnoses 01 Passage of necrotic renal papilla 05 Acute Pyelonephritis 02 Renal Cell-CA with Macrohematuria 01 Prostate-CA with retroperitoneal Metastasis/Obstruction 01 Pancreas-CA with Obstruction 07 Musculoskeletal Pain (LWS-Syndrome)

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Directly visible Stone First Investigation: Sensitivity: 74% Specificity: 93.7% Second Investigation (in 55.7% of cases) in following days: Sensitivity: 81.5% Specificity:100%

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Ureteral Stones and other Parameter Sign “renal colic”: Sensitivity: 77% Hematuria: Sensitivity: 83% Specificity: 80% Obstruction: Sensitivity: 85% Specificity: 50%

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Urereral Stone propable Sign “renal colic” 2 of 3 Parameters exists: Hematuria Obstruction RI-Difference of renal parenchymal arteries ?RI > 0.06

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Ureteral Stone in Ultrasoud* Sensitivity: 98.2% Specificity: 100% *)directly and indirectly signs, and after 2 examinations in 55.7% of cases.

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Therapy of renal colic Outpatient therapy: 83% Inpatient treament: 17% Urologic interventions later: 15% Total out-patient remained: 67%

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Cost of therapy Outpatient 5-10x cheaper as inpatient 2 US and urinary sediment ± 200 Euro Inpatient 1 hospital day(HD) ± 700 Euro, 3 HD 2100 Euro US is made in outpatient practice more often and is cheaper than CT

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