Contemporary diagnostic methods of nephrolithiasis

Abstract

Introduction. Nephrolithiasis is ranked third in the urological diseases, since 2005 it has occupied the first place. A wide range of diagnostic methods available for renal lithiasis evaluation create a well-founded basis for a positive and differential diagnosis of different forms of renal lithiasis. At the same time, the optimal application of the existing imaging arsenal, particularly under the conditions of achieving the maximum cost-benefit ratio, requires to specify the indications for the application of different diagnostic methods. Of particular importance is the determination of the factors causing diagnostic errors as well as the influence of the results of the imaging study on the selection of the concrete treatment method. Aim of the study. To study the contemporary methods of diagnosis of patients with renoureteral calculi, their sensitivity, their indications and contraindications. Materials and methods. The study was conducted in the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, the Republican Clinical Hospital, on a group of 1719 patients with various forms of renal-ureteral lithiasis during 2016-2017. Results. The results obtained show that KUB X-ray was performed in 1700 (98.89%) cases, intravenous urography - 1650 (95.98%), ultrasonography - 1719 (100%), computed tomography - 140 (8.14%) retrograde pyelography - 28 (1.62%), renography - 42 (2.44%), scintigraphy - 24 (1.39%). Unilateral calculi were found in 1420 (82.6%), out of which: in 673 patients (47.3%) they were located on the right side, while in 747 patients (52.7%) they were on the left side. Of 1719 patients enrolled in the study, 787 (45.78%) were males and 932 (54.22%) women. The study group included 367 (21.3%) patients aged 21-39 years, 1002 (58.3%) patients aged 40-59 years and 350 patients (20.4%) over 60 years. Conclusions. The frequency of the disease, the clinical particularities, the possibility of complications, the difficulties that arise in the process of diagnosis and treatment emphasize the need to continuously study the problems related to urolithiasis. Also, imaging methods allow the visualization of calculi and nephrolithiasis complications. This contributes to the improvement of the practical implementation of the conduct algorithm in each individual case, effectively ensuring the medical act customization. The efficacy of each diagnostic method can be evaluated in terms of unanimously accepted sensitivity and specificity, being associated with concrete imaging signs specifically selected for the evaluation of renal lithiasis.