The final report of the research plan
Abstract
Introduction: Timely and accurate diagnosis is very important as the first step in the treatment of urinary stones. Therefore, we decided to compare the new method (Computed Tomography of Kidney, Ureter And Bladder) CT KUB with the conventional method of IVP (Intravenous Pyelography) stone detection.
Materials and methods: During the 1.5-year study period, patients who needed IVP due to renal colic at the discretion of the urologist were identified, and after giving full explanations and obtaining discharge certificates, 27 patients were included in the study. For each of these 27 patients, CT KUB and IVP were performed on the same day, and the stereotypes were reported by a radiologist. If there was any pathology other than stones that could cause acute pain, these cases were also recorded and compared in two methods. Results: Of the 27 people who entered the study, stones were found in 20 cases. CT KUB correctly diagnosed stones for all 20 cases, and in 7 cases where stones were not found, CT KUB did not detect stones either. However, IVP only identified stones in 13 cases. In 5 cases, CT KUB (2 cases of upjo, two cases of abdominal mass, and one case of cyst) and in 2 cases of IVP, another diagnosis (upjo) was suggested to the patient
Conclusion: CT KUB compared to IVP is more accurate in diagnosing urinary stones (100% vs. 65%). CT KUB can also be used to confirm the absence of urinary tract pathology in renal colic. Also, in cases where the cause of acute flank pain is other than stones, CT KUB detects the pathology with higher accuracy than IVP. In cases where the patient has contraindications to the use of contrast material, CT KUB becomes doubly valuable. be KUB.
Keywords: acute flank pain, urinary stones, diagnostic accuracy
Introduction:
Since urinary system stones can cause many discomforts for the patient and even if they are not diagnosed and treated in time, they can cause the loss of kidney function in side are affected, therefore timely diagnosis of these stones is important as the first step for their treatment.
Small urinary stones (smaller than 4 mm) are usually passed by themselves, but larger stones often require invasive measures to be removed. (1)
Usually, before performing invasive approaches for stones, IVP (Intravenous Pyelography) is performed to determine the location of the stone and to some extent the anatomy of the urinary system and kidney function. In this method, a type of iodinated contrast agent is injected intravenously, and after certain times the patient is radiographed. With the entrance of the contrast agent into the collecting system, the calyces, pelvis, ureters and bladder are visible. (2)
But considering the contrast injection in IVP, its expensiveness, systemic side effects and limitations such as the normality of the patient's creatinine and the inaccuracy in the diagnosis of OPEC bread stones (2), we decided to compare the CT KUB technique with IVP. In this method, there is no need to inject contrast and it is done in less than 5 minutes, unlike IVP, which sometimes requires hours to be performed and repeating various stereotypes. The amount of radiation received in IVP is more than CT It is KUB. Radiolucent stones can be easily seen in CT KUB. The sensitivity of this method is excellent in detecting stones less than half a centimeter, especially ureter stones and UVJ (Uretero Vesical Junction). Also, unlike IVP, in which only the anatomical information of the urinary system is obtained, in CT KUB, information can be obtained about the entire anatomy of the abdomen. It gives a suitable surgical approach.
In this research, we want to collect information from IVP performed in patients and simultaneously collect CT KUB information - in the same patients or similar patients - and compare these two together in terms of sensitivity and diagnostic specificity, cost and systemic side effects. We compare.
A - The main goals of the plan:
1. Investigating the diagnostic value of CT KUB in urinary stones and comparing it with IVP in patients with urinary stones in Qom from 1389 to 1391
B- Sub-goals of the plan:
1. A comparative study of the complications of CT KUB and IVP in patients with urinary stones in Qom from 1389 to 1391
2. Investigating the value of CT KUB and IVP in diagnosing stones under 5 mm in patients with urinary stones in Qom from 1389 to 1391
3. A comparative study of the cost-effectiveness of CT KUB and IVP in patients with urinary stones in Qom from 1389 to 1391
4. A comparative study of the amount of anatomical information obtained from CT KUB and IVP in patients with urinary stones in Qom from 1389 to 1391
C- Assumptions - questions :
1. The diagnostic value of CT KUB and IVP in patients with urinary stones in Qom city from 2009 to 2011 is different.
2. The diagnostic value of CT KUB and IVP in the diagnosis of stones below 5 mm in patients with urinary stones in Qom city from 1389 to 1391 is different. 4. The amount of information obtained in CT KUB in patients with urinary stones in Qom city from 2009 to 2011 is more than IVP.
5. The rate of complications of IVP is higher than CT KUB in patients with urinary stones in Qom city from 2009 to 2011. Patients and high cost and the limited number of patients included in the plan
Words and terms:
Urinary stones:
Intra venus pyelography: IVP
Computed tomography of Kidney,urether,bladder:CT KUB
Renal colic: acute flank pain
The second chapter
The knowledge available in the research
The first part: Conceptual framework
Urinary stones are the third most common disease of the urinary system, and only urinary infections and pathological conditions of the prostate are more common. These stones are common in both humans and animals. Words and terms related to urinary stone diseases have been adopted from various sources. For example, struvite stones, which are composed of magnesium ammonium phosphate hexahydrate, are named after H.C.G. von Struve (1772-1851), a Russian naturalist. Before the time of this scientist, the mentioned stones were called ragwanite, because magnesium ammonium phosphate is clearly present in the batdropping. Calcium oxalate dihydrate rock is often called wadlite, because this rock is found abundantly in the bed of the Weddell Sea in Antarctica. The history of terms related to urolithiasis is complex, as is the evolution of interventional techniques for their treatment. Urinary stones have been bothering humans since the beginning of the first civilizations. There are still many points to ponder about the etiology of stones. If the urine content of both kidneys is similar and there is no evidence of obstruction, why do most stones appear unilaterally? Why are small stones not expelled through the ureter without causing any problems in the initial solution of their formation? Why do some people have one big stone and others have many small stones? Many incidents have been raised regarding this and other questions.