Unenhanced helical CT of ureteral stones: a replacement for excretory urography in planning treatment

The purpose of this study was to determine whether unenhanced helical CT alone can be used for diagnosis and treatment planning of patients with obstructing ureteral stones. Medical records of 100 patients with ureteral stones and a clearly discernible clinical outcome who had undergone unenhanced helical CT were reviewed to determine the number of urography procedures and results of excretory urograms performed within 72 hr of helical CT. CT scans were then reviewed by two radiologists for six findings: in-plane stone diameter, z-axis stone diameter, location of stone, periureteral stranding, hydronephrosis, and perinephric fluid. Seventy-one patients passed stones spontaneously, and 29 patients required intervention including basket retrieval, extracorporeal shock-wave lithotripsy, laser lithotripsy, or a combination of the three treatments. Data were analyzed to determine those findings that correlated with the need for intervention. Five excretory urograms were obtained, all of which agreed with findings revealed by CT. Excretory urography added no information. CT findings of in-plane diameter (p < .001), z -axis diameter (p < .001), and location of stone (p = .003) all significantly correlated with the need for intervention. Helical CT can be used in place of excretory urography to plan treatment of patients with flank pain caused by obstructing ureteral stones. Stones that are larger than 5 mm, located within the proximal two thirds of the ureter, and seen on two or more consecutive CT images are more likely to require endoscopic removal, lithotripsy, or both.