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Sunday, November 09, 2014

Not all stones are easy to localize

Some stones can be seen plain as day on a standard x-ray.  Follow-up and treatment of these stones is typically easy and straight forward.  Yet how does the urologist follow the 15% of stones that can be seen at all on plain X-ray  films?   

The options are repeat CT scan, which is expensive and the most radiation intensive (albeit very low dose for adults). 
Renal sonogram is pretty good for kidney stones, especially larger ones and is totally safe.   This modality can also be used to follow ureter stones that are obstructive.  Bladder ultrasound can be used to folllow stones at the junction of bladder and ureter, the UVJ.  Intravenous urography is the final option.  Old school for sure,  the IVP as it is known, is still quite good.  Disadvantages are that the test is time consuming, requires IV dye that may be allergenic and nephrotoxic to some, and utilizes low dose ionizing radiation.