Alkarajeh Mohammad, Abushamma Faris, Ktaifan Mahfouz, Abdallah Abdoh, Aghbar Amir, Akkawi Maha, Maree Mosab, Zyoud Sa'ed H
Department of Nephrology, An-Najah National University Hospital, Nablus, PSE.
Department of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, PSE.
Cureus. 2025 Aug 18;17(8):e90365. doi: 10.7759/cureus.90365. eCollection 2025 Aug.
Background This study aims to identify the reliability of kidney-ureter-bladder (KUB) radiography as a triage tool in acute ureteral colic (AUC). Moreover, this article correlates between KUB and non-contrast computerized tomography (NCCT) in view of stone characteristics and clinical outcomes. Methodology A retrospective cohort study recruited patients who had proven ureteric stones on NCCT. A blinded review of KUB and NCCT was performed to identify the following variables in both tests: site, ureteric stone maximum diameter, and stone density. Correlation between KUB radiography and NCCT has been performed. The intermethod reliability was used to measure the degree to which test scores are consistent when the methods or instruments employed vary. Results One hundred fifty-one patients were included, of whom 75 (50%) had negative KUB and positive NCCT results for ureteric stones based on the blinded review. Lower ureteral calculi were found to be the most common location in both KUB (= 49, 65%) and NCCT images (= 81, 54%). The median stone diameters of KUB and NCCT were 5 (3-8) mm and 6 (4-9) mm, respectively. Hounsfield unit densities of more than 630 were found in 86 (57%) patients, and radiopaque stones were found in 76 (50%) patients. There was moderate and significant concordance (Cohen's kappa = 0.520) between NCCT and KUB regarding stone location (< 0.01). There was a strong concordance (Cohen's kappa = 0.804) between NCCT and KUB in detecting ureteric stone maximum diameter (< 0.01). Stone density was weakly correlated between KUB and NCCT (Cohen's kappa = 0.254) (= 0.001). Thirty-four cases (45%) of negative KUB results required surgical intervention (SI). Sepsis (= 5, 15%) and acute kidney injury (= 23, 68%) were the main indications for SI in negative KUB and positive NCCT ureteric stones. Conclusions KUB radiography should not be used as a triage tool in AUC due to potentially harmful outcomes. However, KUB radiography can be reliably used during follow-up, as there is a strong correlation between KUB radiography and NCCT for KUB-detectable ureteric stones.
背景 本研究旨在确定肾输尿管膀胱（KUB）X线摄影作为急性输尿管绞痛（AUC）分诊工具的可靠性。此外，本文鉴于结石特征和临床结果，对KUB和非增强计算机断层扫描（NCCT）进行了相关性分析。方法 一项回顾性队列研究纳入了经NCCT证实有输尿管结石的患者。对KUB和NCCT进行盲法评估，以确定两项检查中的以下变量：部位、输尿管结石最大直径和结石密度。对KUB X线摄影和NCCT之间的相关性进行了分析。采用方法间可靠性来衡量当所采用的方法或仪器不同时，测试分数的一致程度。结果 共纳入151例患者，其中75例（50%）根据盲法评估，KUB结果为阴性而NCCT结果为输尿管结石阳性。在KUB（=49，65%）和NCCT图像（=81，54%）中，输尿管下段结石均为最常见部位。KUB和NCCT的结石中位直径分别为5（3 - 8）mm和6（4 - 9）mm。86例（57%）患者的Hounsfield单位密度超过630，76例（50%）患者发现不透X线结石。在结石部位方面，NCCT和KUB之间存在中度且显著的一致性（Cohen's kappa = 0.520）（<0.01）。在检测输尿管结石最大直径方面，NCCT和KUB之间存在强一致性（Cohen's kappa = 0.804）（<0.01）。KUB和NCCT之间结石密度的相关性较弱（Cohen's kappa = 0.254）（=0.001）。34例（45%）KUB结果为阴性的病例需要手术干预（SI）。脓毒症（=5，15%）和急性肾损伤（=23，68%）是KUB阴性且NCCT输尿管结石阳性患者SI的主要指征。结论 由于可能产生有害后果，KUB X线摄影不应作为AUC的分诊工具。然而，KUB X线摄影在随访期间可可靠使用，因为KUB X线摄影与NCCT对于KUB可检测到的输尿管结石之间存在强相关性。
