Is CTKUB the gold standard in assessing flank pain with diagnostic uncertainty? A one-year review of 228 cases

Abstract

The use of computed tomography of the kidneys, ureters and bladder (CTKUB) in a "renal colic pathway" has been reported to yield high diagnosis rates and also identifies other non-urological pathology accounting for patients’ symptoms. Our study explores the diagnostic yield of CTKUB as the first-line investigation for suspected renal colic with regard to urolithiasis and additional findings. All CTKUB performed in cases of suspected renal colic were extracted from our radiology database from 1 April 2010 to 1 April 2011. Extracted information included: demographics, the department ordering the investigation, presence of ureteric calculi, presence of renal calculi and any additional findings that could account for patients’ symptoms, or otherwise. During the study 228 CTKUB were performed. The diagnosis rate of ureteric calculi was 33.7%. In the absence of a ureteric stone, additional findings as well as alternative diagnoses were higher (additional finding 49.7% (n=75) vs. 35% (n=27); alternative diagnosis 33.1% (n=50) vs. 15.6% (n=12) p < 0.05). In patients with ureteric calculi, the alternative diagnosis yield of 15.6% falls within the range of that previously documented. This study illustrates that when diagnostic clarity is not reached, CTKUB is being overused. This leads to unnecessary radiation exposure and resource wastage.