PURPOSE: Central lucency of pelvic phleboliths is frequently observed on plain pelvic radiographs. When it is also present on noncontrast helical CT images, pelvic phleboliths may be easily diagnosed, with no suspicion of distal ureteral calculi. The objective of this study was to determine the frequency with which this phenome-non is seen on plain radiographs and noncontrast helical CT images. MATERIALS AND METHODS: During a recent two-year period we identified 70 patients with renal colic who under-went both abdomino-pelvic radiography and noncontrast helical CT scanning. Radiographs were obtained at 70 -85 kVp and 30 -40 mA; CT scans were preformed within one month of plain radiography with parameters of 120 kVp, 200 -220 mA, 5-mm collimation, and pitch of 1 -1.6, and using soft tissue and bone window settings. With regared to the central lucency of pelvic phleboliths, as seen on both on radiographs and CT im-ages, two experienced radiologists reached a consensus. RESULTS: Among the 70 patients, a total of 150 pelvic phleboliths was found. In all cases except one, pelvic radi-ography and noncontrast helical CT revealed the same number of phleboliths. The exception was a case in which one of two phleboliths demonstrated by CT was not seen on radiographs. Pelvic radiography revealed central lucency in 95 of these 150 phleboliths (63%), but noncontrast helical CT failed to depict a hypodense center in any phlebolith. CONCLUSION: Central lucency of pelvic phleboliths, as frequently seen on plain pelvic radiographs, was not revealed by routine noncontrast helical CT in any patient.The presence or absence of central lucency on these CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.
Consensus ; Humans ; Radiography ; Renal Colic ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Ureteral Calculi

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.
Adult ; Colic/*radiography ; Female ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ureteral Calculi/*radiography ; Ureteral Diseases/*radiography ; *Urography

PURPOSE: The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. MATERIALS AND METHODS: A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. RESULTS: Mean stone size in the LD group was significantly smaller than that in the HD group (7.5+/-1.4 mm compared with 9.9+/-2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. CONCLUSIONS: Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure.
Adult ; Aged ; Colic ; Female ; Humans ; *Lithotripsy ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Ureteral Calculi/*radiography/*therapy

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.
Adult ; Female ; Humans ; Kidney Pelvis/pathology ; Male ; Middle Aged ; Renal Colic/drug therapy/*pathology/radiography ; Retrospective Studies ; Sulfonamides/therapeutic use ; Tomography, X-Ray Computed ; Treatment Failure ; Ureter/pathology ; Ureteral Calculi/drug therapy/*pathology/radiography ; Urological Agents/therapeutic use