role of unenhanced helical computed tomography scan in the diagnosis of acute renal colic

Patients presenting in the emergency room [ER] with flank pain suggestive of renal or ureteric stones may have alternative underlying conditions mimicking urolithiasis. An early diagnosis and appropriate treatment for urolithiasis and other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT [UHCT] for evaluation of renal colic. This study was conducted to define the importance of UHCT as an alternative to US and IVP in cases of acute renal colic with suspected renal or ureteric stones as a cause of pain and to define the incidence and spectrum of significant incidental diagnosis other than renal or ureteric stones. 43patients presented at ER with acute loin pain were reviewed with UHCT for suspected renal or/ureteral stones. Radiological diagnosis of clinical entities not suspected otherwise was analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Renal stones were identified in 11 patients [25.6%], ureteral calculi were identified in 16 patients [37.2%], findings of recent passage of calculi in 2 patients [4.7%] and no calculi in 14 patients [32.5%]. Overall the incidental findings [additional or alternative diagnosis] were found in 3 [6.9%] CT scans of all patients; and [21%] of nonurinary calcular patients. Diagnosis was confirmed by peri-operative findings, and other radiological and biochemical investigations or on clinical follow up. UHCT is more beneficial than US and IVP in ER for accurate and rapid management of cases of acute renal colic as a wide spectrum of significant incidental diagnosis - other than stones - can be identified on UHCT performed for suspected renallureteral stones. In the present series of 43 CT examinations, Urolithiasis was appeared in 67.5% of cases. The incidence of incidental diagnosis of pathologies other than urolithiasis was 6.9% of all patients 21% of patients with no calculi

Safety and efficacy of supracosatal access for percutaneous nephrolithotomy: a 3-year experience

Successful removal of stones in percutaneous nephrolithotomy requires the accurate placement of a percutaneous track that provides direct access for stone manipulation. Supracostal approach is usually avoided be-cause of concerns about potential chest complications. We evaluated the hazard, safety and efficacy of supracostal approach for percutaneous nephrolithotomy. During the years 2003-2005 a total of 24 patients underwent PCNL through a supracostal track at Al-Hussain University Hospital. The indications for a supracostal approach were upper caliceal stone resistant to ESWL, upper caliceal stone with narrow neck, upper ureteric stone, Staghorn stone and sizable pelvic stone in a highly situated kidney. In 22 patients the punctures were performed just above the 12th rib; while in 2 cases the punctures were performed above the 11th rib. The data were analyzed for stone clearance, intra-operative and post-operative complications. Twenty one patients [87.5%] were rendered stone-free or had clinically insignificant residuals by PCNL alone. Overall complication was [20.8%]. Chest complications developed in only 2 patients [8.3%] in the form of hydro-pneumothorax and were managed successfully by intercostal chest tube drainage with an under water-seal connection. The study concluded that with proper choice of candidates, supracostal access for PCNL is safe and effective. The possible inadvertent pleural injury is rare and is easily manageable