| Abstract: |
SUMMARY AND CONCLUSIONThis study was carried out in Urology and Radiology departments Zagazig University Hospitals over a period from February 2001 till January 2004. It included one hundred patients presented with acute flank pain. The age of these patients ranged from 18-71 years with a mean age 52 year’s .In this study we studied the role of UHCT in diagnosis and management of acute flank pain and compared it with IVP. Patients underwent complete clinical evaluation, laboratory investigation, UHCT and IVP (not for all patients). Imaging findings were compared to final data that obtained after treatment of the patients. UHCT was valuable for evaluating and managing acute flank pain. It had been proved that the application of un-enhanced helical Computerized Tomography (UHCT) for diagnosis and management of ureteral colic is altering dramatically the practice of urology and diagnostic uroradiology and has become the mainstay for diagnosis of ureteral colic in many institutions by identifying ureteral calculi directly within the course of the ureter. Once a stone is identified, its site and size are accurately assessed. Identification of stone composition by measuring CT number (attenuation value) plays an increasingly important role in planning the management; however, the CT number may be thought of as indication of the relative fragility of the stone rather than an accurate method for determining the exact chemical composition, with the main advantage of this approach being that it provides a rapid assessment at no extra cost or time consumption.Also, the secondary signs of obstruction are of equal importance in establishing the diagnosis of ureterolithiasis. When ureterolithiasis is absent, UHCT is able to diagnose a wide range of causes of acute flank pain as appendicitis, as ovarian masses that have undergone torsion or haemorrhage, diverticulitis and cholecysitis.In our study, UHCT has proved to be (100 %) sensitive and (97%) specific in diagnosing patients presenting with acute flank pain with an overall accuracy of (95 %).Advantages of UHCT:1) CT is more accurate than excretory urography and has a reported sensitivity of 100%, specificity of 97% and positive predictive value of 98% and negative predictive value of 89%.2) CT is able to detect calculi regardless of their chemical composition, because all calculi have Hounsfield units greater than 200, including uric acid calculi.3) UHCT is carried out without intravenous contrast material, which reduces cost and examination time, and particularly eliminates the risk of allergic reactions and nephrotoxicity.4) Another advantage of UHCT is the short examination time. The information is acquired in about 10 minutes, in most cases, whereas IVU may be carried out for hours in cases of high grade obstruction before the exact point of obstruction is defined.5) UHCT can precisely determine stone location, which is valuable for treatment planning as ESWL for proximal stones or ureteroscopic intervention for distal stones.6) UHCT allows precise determination of stone size, which is essential for planning the management of the patient.7) UHCT can predict the composition of the stones.8) UHCT surveys the entire abdomen and pelvis, not only the urinary tract and may therefore reveal unsuspected pathology responsible for the patient symptoms.9) No bowel preparation is required for a successful examination
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