Ghali A M, Elmalik E M, Ibrahim A I, Abdulhameed E, el Tahir M I
Asir Central Hospital, Abha, Saudi Arabia.
Eur Urol. 1998;33(6):529-37. doi: 10.1159/000019650.
To develop a cost-effective plan for the accurate diagnosis of urinary stone patients presenting with ureteric colic based on an assortment of investigations which are less invasive and more economical than intravenous urography (IVU).
143 consecutive emergency patients presenting with ureteric colic were admitted to hospital and prospectively studied by history recording, physical examination, laboratory tests and imaging procedures according to a preset format. Significant association of the final diagnosis of urinary stones (which was made by actual stone retrieval) with various diagnosis variables obtained from the results of investigation (including IVU) was statistically studied using bivariate correlation and multivariate logistic regression analysis. Algorithms for reaching an accurate diagnosis of urinary tract stones were formulated using the most significant diagnostic variables and the accuracy of each of those plans was compared with that of emergency IVU.
18 patients were excluded for various reasons. Of the remaining 125 patients 82 (66%) were confirmed as having urinary stones. A positive IVU had the strongest correlation with the final diagnosis of urinary tract stones. Other findings associated with eventual stone retrieval in a descending order of significance were: calcular sonographic features; radio-opacities on a plain abdominal film of the kidney, ureter and bladder (KUB), and microhaematuria. Based on these findings two algorithms could be formulated to reach as accurate a diagnosis as possible. Algorithm A in which an initial ultrasound is mandatory had a sensitivity of 89%, a specificity of 88% and an overall accuracy of 88% for urinary stone detection compared with 91, 77, and 86%, respectively, for algorithm B in which ultrasonography was employed selectively after initial KUB and urinalysis for microhaematuria. This compares with 94, 79, and 89%, respectively, for IVU.
Both plans are viable alternatives which could replace routine emergency IVU.
基于一系列比静脉肾盂造影（IVU）侵入性更小且更经济的检查，制定一项针对输尿管绞痛的尿石症患者进行准确诊断的经济有效计划。
143例连续因输尿管绞痛就诊的急诊患者入院，并按照预设格式通过病史记录、体格检查、实验室检查和影像学检查进行前瞻性研究。使用双变量相关性和多变量逻辑回归分析，对通过实际取出结石做出的尿石症最终诊断与从检查结果（包括IVU）获得的各种诊断变量之间的显著关联进行统计学研究。使用最显著的诊断变量制定用于准确诊断尿路结石的算法，并将每个计划的准确性与急诊IVU的准确性进行比较。
18例患者因各种原因被排除。在其余125例患者中，82例（66%）被确诊为患有尿石症。IVU阳性与尿路结石的最终诊断相关性最强。与最终结石取出相关的其他发现按重要性降序排列为：结石超声特征；肾脏、输尿管和膀胱（KUB）腹部平片上的不透X线阴影，以及镜下血尿。基于这些发现，可以制定两种算法以尽可能准确地进行诊断。算法A强制进行初始超声检查，其对尿石症检测的敏感性为89%，特异性为88%，总体准确率为88%；相比之下，算法B在初始KUB和镜下血尿尿液分析后选择性使用超声检查，其敏感性、特异性和总体准确率分别为91%、77%和86%。IVU的相应数值分别为94%、79%和89%。
这两种方案都是可行的替代方案，可取代常规急诊IVU。
