Ultrasound at the patient’s bedside for the diagnosis and prognostication of a renal colic

Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p < 0.01). Conversely, distal ureteral stones with a diameter of < 6 mm were managed with medical ambulatory treatment (p < 0.05). Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.

Effect of Transurethral Resection of the Prostate on Urodynamic Parameters in Patients with Benign Prostatic Enlargement with Upper Urinary Tract Dilatation

<b><i>Objective:</i></b> To evaluate the urodynamic outcomes of transurethral resection of the prostate (TURP) in patients of benign prostatic enlargement (BPE) with upper urinary tract dilatation and correlate with International Prostate Symptoms Score (I-PSS). <b><i>Methods:</i></b> In this prospective study, patients of BPE with upper urinary tract dilatation from July 2017 to June 2019 were enrolled. At presentation, detailed I-PSS, ultrasonography abdomen, serum creatinine, and serum PSA were recorded. All the patients were catheterized and observed for postobstructive diuresis. At 4 weeks, repeat ultrasound and serum creatinine were recorded. Urodynamic study (UDS) was performed after ensuring sterile urine culture. Patients underwent TURP as per the standard technique. A repeat UDS was performed after 3 months, and analysis was done. <b><i>Results:</i></b> Forty-four patients were enrolled of which data of 37 patients were analyzed. In the filling phase of the UDS, there was a significant decrease in detrusor pressure at the end filling phase from 27 to 9.0 cm H₂O after TURP. Maximum cystometric capacity and bladder compliance significantly improved at 3 months following surgery. In the voiding phase, peak flow rate showed a significant increase, postvoid residual urine volume significantly decreased, and peak detrusor pressure marginally decreased following TURP. The I-PSS decreased from 20 ± 8 to 5 ± 6 following TURP. <b><i>Conclusion:</i></b> High detrusor pressure and reduced compliance is a risk factor for upper urinary tract dilatation. Changes in the bladder dynamics and resolution of hydronephrosis following TURP reflected in the changes in urodynamic parameters and I-PSS.

Antenatally detected urinary tract dilatation: a 12–15-year follow-up

Background Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD. Methods Seventy-one out of 103 children born in 2003–2005 and diagnosed with antenatal UTD agreed to participate in a 12–15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections. Results Among children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32–39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2. Conclusions We conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.