Impact of imaging in urolithiasis treatment planning

Over the past 10 years, we have seen major advances in urological imaging including developments in digital imaging, ultrasound and computerized tomography (CT) scanning. All of these have had an impact on the management of urinary tract stone disease. In parallel with these, we have witnessed a greater appreciation of the potential harm of irradiation exposure. In this article, we aim to provide an overview of the impact of imaging in urolithiasis treatment planning in 2013.

A variety of imaging modalities are reviewed with a focus on the latest research and developments. Advances do not always improve quality, and the deterioration in digital KUB sensitivity is discussed. The role of ultrasonography in the diagnosis and follow-up of stone disease is explored as a clinically valuable alternative to ionizing radiation. The explosion of interest in cross-sectional imaging for urolithiasis (extending from the evaluation of loin pain, characterization of stone composition through to complex three-dimensional reconstructions of the pelvicalyceal system for surgical planning) is reviewed.

A detailed understanding of the performance of all the imaging modalities available to the stone surgeon in 2013 is vital in order to offer well tolerated and effective imaging strategies for all stages of the patient journey. CT has developed a pre-eminent role in the diagnosis of urinary stone disease, it has also found favour as a valuable surgical planning tool and is being advocated in the surveillance protocols. However, we must keep in mind the risks of radiation exposure in a patient population characterized by youth and a susceptibility to repeated acute disease episodes.