Comparative study between ultrasound & KUB and IVU in renal colic patients in Kelantan
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Date
2001
Authors
Ismail, Harith Sherifuddin
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Intravenous urography has been a standard investigative method in patients
with nephrolithiasis. Routine use of intravenous urography has shown to increase
examination time and cost. Besides, it requires ionizing radiation and contrast media that
carries a risk to the patient. Ultrasound can detect calculi and dilatation of the
peJvicalyceaJ system. Combination of KUB and US can significantly improve the
detection of calculi especially at the ureter. The study illustrates the effectiveness of
ultrasound and KUB in evaluating renal colic patients compared to IVU. The specific objectives in this study are to assess the
usefulness of ultrasound with or without KUB in the evaluation of renal colic.
Pelvicalyceal system dilatations or any other lesions noted in IVU and US were also
evaluated. The age, sex, race and geographical distribution of patients were noted. A twoyear
prospective study was performed from I st July 1998 till July 2000 in 100 patients
who presented with renal colic. The study was conducted in Hospital USM and Hospital
Kota Bharu. Intravenous urography was performed with bowel preparation. Non-ionic
contrast media were used in all of the patients. Patients with history of asthma or allergic
to seafood were properly covered with prednisolone. No com pi ication noted in all of the patients. A plain film (KUB) was done as part of IVU films. Ultrasound was performed
immediately after IVU or just after full bladder view film was taken. Calculi were noted in 61 patients both IVU and US. Nine patients showed false
negative of ultrasound in detecting calculi. Intravenous Urography showed that these
calculi were actually in the ureters. Six patients showed false positive for calculi in US.
The sensitivity and specificity of US in detecting calculi were 87.4% and 80.0%
respectively. Both KUB and IVU detected calculi in 65 patients. Five false negative
noted in KUB, which were actually radiolucent stones. No false positive noted in KUB.
The sensitivity and specificity of KUB in detecting calculi were 92.9% and I 00%
respectively. The high sensitivity and specificity of KUB were due to the fact that it was
done the control film for the IVU examination. A detection bias probably occurred.
Combinations of US & KUB in detecting calculi were significantly increased the
effectiveness of US in detecting calculi. The sensitivity was 95.7% and specificity
remains 80.0%. Ultrasound also showed high sensitivity in detecting hydronephrosis. The
sensitivity and specificity were 98.1% and 86.7% respectively. There were significant
correlations between KUB, US and IVU in detecting calculi and between IVU and US in
detecting hydronephrosis. Ultrasound and KUB X-ray have significantly improved the detection of
calculi compared to ultrasound alone. Kidney, Ureter and Bladder X-ray (KUB) helps US
in the detection of calculi in the ureter. However. the drawback of KUB was it is unable
to detect radiolucent calculi. Ultrasound played a complementary role in this situation. Intravenous urography still remains the gold standard method in evaluating the cause and
level of obstruction. Routine use of IVU should be reserved for patients undergoing
ESWL and for patients with persistent colic in whom US & KUB were not diagnostic.
Description
Keywords
Ultrasound & KUB and IVU