Hematuria as a Sign of Kidney Stone Disease Evaluated Using Computed Tomography: A Review

Area of Science:

• Urology
• Radiology
• Medical Imaging

Background:

• Kidney stones (renal calculi) are a prevalent urinary system pathology affecting 12% of the world's population.
• Calculi formation in the ureters, kidneys, and bladder frequently leads to hematuria, a common cause of acute abdominal pain.
• Effective diagnostic imaging is crucial for evaluating patients with suspected kidney stones and hematuria.

Purpose of the Study:

• To identify the most accurate imaging technique for diagnosing kidney stones and associated hematuria.
• To establish evidence-based guidelines for imaging selection based on patient demographics and hematuria presentation.
• To critically evaluate existing research on kidney stone diagnostics using a structured quality assessment scale.

Main Methods:

• A systematic literature search was conducted using PICO-formatted questions and MeSH terms like "renal calculi" and "hematuria".
• Studies meeting specific criteria were critically evaluated using a unique quality assessment scale.
• Comparative analysis of diagnostic accuracy for various imaging modalities was performed.

Main Results:

• Unenhanced helical computed tomography (CT) is highlighted as an effective initial imaging technique for calculi.
• Multidetector CT (MDCT) is identified as the most accurate imaging diagnostic test for patients with hematuria.
• Specific imaging recommendations are provided: non-contrast CT or ultrasound for microscopic hematuria in patients over 40, adding cystoscopy for gross hematuria; elderly patients require pre- and post-contrast CT with cystoscopy.

Conclusions:

• Multidetector computed tomography offers the highest accuracy for diagnosing kidney stones and hematuria.
• Tailored imaging strategies, considering patient age and hematuria type, improve diagnostic yield.
• Evidence-based guidelines support the use of MDCT and cystoscopy for optimal kidney stone evaluation.