BERKELEY, CA (UroToday.com) - Although pediatric urolithiasis is rarer in children compared with adults, the incidence of pediatric urolithiasis appears to be increasing (although the exact reasons for this increase remain elusive).
Children with urolithiasis are particularly vulnerable because they are susceptible to multiple stone episodes and potentially numerous imaging studies over their lifetimes. The treatment modalities used to remove urinary tract stones such as ureteroscopic or extracorporeal lithotripsy can also add incremental radiation exposure as well. Younger patients are additionally more sensitive to ionizing radiation compared with adults. When it comes to diagnostic and therapeutic radiation adhering to the principles of ALARA (as low as reasonably achievable) is paramount in this patient group.
With this context in mind, our group sought to examine the imaging practices used in our population of 42 pediatric stone patients who progressed to procedural intervention at the University of Michigan over a 6 year time period. In brief, we found 50% of our patients underwent a non-contrast CT (NCCT) for either diagnosis or treatment planning. However upon review of the details of each case, only 5/21 (23.8%) were necessary for diagnosis or treatment planning, and thus 37/42 of our patients could have undergone complete diagnostic work-up and treatment without the radiation of an abdominal CT.
NCCT has been the gold standard for the evaluation of suspected urinary tract calculi in adults for nearly 2 decades. Advantages include the rapidity of the test and diagnostic accuracy compared with plain radiography and ultrasound. Despite these advantages it is not clear that NCCT should be the first line imaging study in children particularly when reasonable alternative modalities exist. Given that nearly 90% of our patients could have avoided cross-sectional imaging, we suggest any pediatric patient presenting with signs and symptoms of urolithiasis should be first evaluated with US, then plain abdominal x-ray. NCCT should then be obtained only if the index of suspicion for stone disease remains high and the US and KUB findings are equivocal or negative. When NCCT is deemed necessary, adherence to lower-dose pediatric radiation protocols is of utmost importance.
Thank you very much for publishing our abstract on urotoday.com. We hope that this manuscript, published in the September 2011 issue of Urology , highlights the fact that many children with clinically significant urolithiasis can be diagnosed and managed with a renal ultrasound and/or plain radiography alone, obviating the need for CT in most cases.
Written by:
Emilie K. Johnson, MD., and Julian Wan, MD. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi - Abstract
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