Investigation of acute flank pain: how do practices of U.K.and Irish urologists compare with those of transatlantic and continental European colleagues?
OBJECTIVE
Noncontrast-enhanced spiral CT (NESCT) is more accurate and reliable than intravenous urography (IVU) in diagnosing the cause of acute flank pain. This study aimed to determine the impact of current literature on the choice of imaging modality used to investigate acute flank pain within the UK and the Republic of Ireland.


METHODS
A questionnaire regarding the preferred investigation for acute flank pain was sent to all consultant urologists registered as British Association of Urological Surgeons members.


RESULTS
Of the 548 consultants from 210 institutions surveyed, 293 (54%) from 171 (81.4%) institutions returned their questionnaires. Intravenous urography is used in the majority of institutions (146; 85.4%) for investigating acute flank pain. Only 18 (10.5%) use NESCT, while 4.1% use ultrasonography. Among those using IVU as the investigation of choice, the main reason given was limited CT services (82.4%). Others included familiarity with IVU features (51.2%), limited availability of radiologists for out-of-hours reporting of CT (26%), more rapid procedure (20.8%), lower cost (20%), and lower radiation exposure (19.6%). Only 52.4% of consultants using IVU would prefer NESCT if both were equally available.


CONCLUSIONS
Urography remains the commonest modality for the investigation of acute flank pain in the UK and Ireland primarily because of limited CT services and greater familiarity with the images. Given the opportunity, only half of consultant urologists would select NESCT in preference to IVU, suggesting that improving the availability of CT services alone may not lead to practice paralleling that of our transatlantic and continental European colleagues.
Otite
Ugo
U
Department of Urology, Royal Shrewsbury Hospital, Shrewsbury, United Kingdom. UAOTITE@aol.com
Parkin
John
J
Waymont
Brian
B
Inglis
John A
JA
Philp
Nigel H
NH
D000208:Acute Disease; D003287:Contrast Media; D021501:Flank Pain / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007262:Infusions, Intravenous; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D036542:Tomography, Spiral Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data; D006113:United Kingdom; D014567:Urography / Q000706:statistics & numerical data
D003287:Contrast Media