Rolul radiografiei de ansamblu şi urografiei intravenoase în diagnosticul multimodal al nefrolitiazei complicate

Abstract

Kidney stone disease is in the third place of the lethal causes in patients with urological pathologies. For the last years in Moldova the number of nephrectomies has obviously increased because of complicated and infected kidney stones. The aim of this study is to evaluate the sensitivity and specificity of such radiological methods as kidney, ureter, bladder (KUB) radiography and intravenous urography (IVU) in the multimodal diagnosis of complicated urolithiasis. А total of 1031 patients with complicated nephrolithiasis have been enrolled in the trial, where 3373 basic imaging procedures for diagnostic assessment have been made, on average – 3,3 investigations per patient. The contemporary methods of treatment compared to the traditional ones have requested on average more investigations: 3.7 ± 0.12 versus 3.22 ± 0.09, (p < 0.05). The IVU is associated with a significant increase in sensitivity and specificity in the diagnosis and evaluation of urolithiasis compared to the KUB radiography. Also, this diagnostic method has a superior sensitivity in the detection of pathological changes compared to ultrasound. The IVU provides valuable information about diagnostic characteristics of kidney stones, but also has some disadvantages such as variability in the diagnostic values depending on the preparation of the patient for the investigation (the visualization is hampered due to abdominal bloating), the risk of the adverse effects from the introduction of a contrast substance, limited application for the patients with renal colic and kidney failure. The IVU method may be recommended in the cases when the management of patients depends on the functioning of affected kidneys, or when the computer tomography is not accessible.