CT v US
he rate of important missed diagnoses that resulted in complications, such as pyelonephritis with sepsis or diverticular abscess, was similar and not statistically different between the groups (0.5 percent with ultrasonography versus 0.3 percent with CT).
initiate treatment with tamsulosin (0.4 mg once daily) for four weeks
Patients are then re-imaged if spontaneous passage has not occurred
wiht period measurement of Cr to ensure no development of AKI
International guidelines from the American Urological Association and the European Association of Urology on the management of ureteral calculi suggest that:
●“In a patient who has a newly diagnosed ureteral stone <10 mm and whose symptoms are controlled, observation with periodic evaluation is an option for initial treatment. Such patients may be offered an appropriate medical therapy to facilitate stone passage during the observation period. In a choice between active stone removal and conservative treatment with MET, it is important to take into account all individual circumstances that may affect treatment decisions. A prerequisite for MET is that the patient is reasonably comfortable with that therapeutic approach and that there is no obvious advantage of immediate active stone removal”
- Ultrasonography versus computed tomography for suspected nephrolithiasis.
- Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA Jr, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR
N Engl J Med. 2014 Sep;371(12):1100-10.