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Kidney stone disease: Difference between revisions
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A low-dose non-contrast [[CT]] is usually the first choice as this has little radiation exposure and can detect the majority of stones. [[Ultrasonography]] is a reasonable alternative first choice, especially in pregnant and children, but many stones are not visible on ultrasound (70% sensitive and specific). Kidney, ureter, bladder (KUB) [[radiography]] was previously widely used, but it is not sensitive and so is rarely used nowadays. | A low-dose non-contrast [[CT]] is usually the first choice as this has little radiation exposure and can detect the majority of stones. [[Ultrasonography]] is a reasonable alternative first choice, especially in pregnant and children, but many stones are not visible on ultrasound (70% sensitive and specific). Kidney, ureter, bladder (KUB) [[radiography]] was previously widely used, but it is not sensitive and so is rarely used nowadays. | ||
If the stone causes urinary obstruction, one may see [[hydronephrosis]] and dilated proximal ureters.<section end="radiology" /><section end="urology clinical" /> | If the stone causes urinary obstruction, one may see [[hydronephrosis]] and dilated proximal ureters.<section end="radiology" /><section end="urology clinical" /><section begin="urology management" /> | ||
== Management == | == Management == | ||
Asymptomatic stones need no management or follow-up. Uncomplicated small (< 5 mm) stones need only symptomatic treatment and follow-up imaging after 4 - 6 weeks to see if the stone has passed. These cases can be treated out-patient. | Asymptomatic stones need no management or follow-up. Uncomplicated small (< 5 mm) stones need only symptomatic treatment and follow-up imaging after 4 - 6 weeks to see if the stone has passed. These cases can be treated out-patient. | ||
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=== Symptomatic treatment for renal colic === | === Symptomatic treatment for renal colic === | ||
An [[NSAID]] like ketorolac or diklofenac is the best first choice for renal colic. In addition to relieving pain they also decrease ureteral smooth muscle tone. Hydration, preferably intravenous, is important. A spamsolytic like [[butylscopolamine]] may be used as well. | An [[NSAID]] like ketorolac or diklofenac is the best first choice for renal colic. In addition to relieving pain they also decrease ureteral smooth muscle tone. Hydration, preferably intravenous, is important. A spamsolytic like [[butylscopolamine]] may be used as well. | ||
<section end="urology management" /> | |||
=== Extracorporeal shockwave lithotripsy (ESWL) === | === Extracorporeal shockwave lithotripsy (ESWL) === | ||