Non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in the patients with refractory renal colic.
OBJECTIVE
To assess the importance of combined use of non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in evaluation of patients with refractory flank pain in the emergency department.


METHODS
The study involved 64 consecutive patients with refractory renal colic. All patients were evaluated with plain abdominal films kidneys, ureters and bladder (KUB), NCCT and DRS. We assessed the accuracy of different diagnostic procedures and their combinations; in addition, we determined their importance for different steps of evaluation.


RESULTS
Urololithiasis was diagnosed in 76.6% (n=49) of the patients. Twenty-nine percent of calculi were > 4 mm. Surgical intervention were performed in 20 patients (40.8%). A combination of NCCT plus DRS yielded the greatest sensitivity (96%) in establishing final diagnosis, however clinical, laboratory and KUB data in combination with DRS, yielded greater specificity (93%) and PPV (97%). Sex (male), WBC (mean 10.2 x 10(3) +/- 3.1) and KUB (calculus > 4 mm) were chosen in the three-step multi-variant analysis, while only male sex was found to be the strongest predictor (p<0.056) of necessity to perform NCCT. In making decision for definitive treatment NCCT and DRS provided the most important information about stone size and obstruction (kappa=0.734, p<0.001 and kappa=0.625, p<0.001), while DRS was selected as the most important diagnostic procedure in the emergency department (kappa=0.527, p<0.001).


CONCLUSIONS
In the emergency department, DRS combined with the results of clinical investigation may indicate candidates for hospitalization with emergency intervention. Immediate NCCT must be strongly considered in men with WBC> or =10 x 10(3) and calculi > 4 mm on the KUB.
Kravchick
Sergey
S
Department of Urology, Barzilai Medical Center, Ashkelon, Israel.
Stepnov
Eugeny
E
Lebedev
Valery
V
Linov
Lina
L
Leibovici
Octavian
O
Ben-Horin
Clara L Dosoretz
CL
Trejo
Leonardo
L
Peled
Ronit
R
Cytron
Shmuel
S
D000328:Adult; D000368:Aged; D000465:Algorithms; D003085:Colic / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014513:Ureter / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014545:Urinary Calculi / Q000175:diagnosis