Benefits of CT urography in patients presenting to the emergency department with suspected ureteric colic

D Ulahannan, C J Blakeley, N Jeyadevan, K Hashemi
Emergency Medicine Journal: EMJ 2008, 25 (9): 569-71

BACKGROUND: Ureteric colic is a common presentation in the emergency department and accounts for approximately 1% of all hospital admissions. Diagnosis depends on a typical history, clinical examination and the presence of haematuria. Intravenous urography has traditionally been used as the means of investigation, but over recent years this has been superseded by CT urography. This latter investigation gives potentially more information and may detect alternative or additional pathology which would otherwise be missed on intravenous urography.

METHODS: 100 consecutive patients attending the emergency department with a provisional diagnosis of ureteric colic undergoing CT urography were studied to detect the incidence of alternative or incidental pathology.

RESULTS: Stone disease was found in 58% of patients, with obstruction present in 43%. The most common site of obstruction was the vesicoureteric junction. Significant incidental or alternative pathology was found in 16% of patients. It was estimated that, in 12%, these findings would not have been detected by intravenous urography.

CONCLUSION: The use of non-contrast CT urography is recommended in the initial investigation of patients with ureteric colic.

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