Diagnosis and treatment of urolithiasis

Ureteral stones are a common cause of emergency department presentations of patient with abdominal pain. In the diagnosis and management of ureteral stones, CT has become the imaging modality of choice. CT provides critical information for management, including the size of the stone and its location within the ureter. CT also provides additional information about surrounding abdominal structures that may lead to inclusion or exclusion of alternative diagnoses. In patients with a history of ureteral stones and without complicating factors, plain radiographs may be obtained; however, for most other patients, noncontrast CT is the imaging of choice. Stones less than 0.5-cm size have approximately a 98% chance of spontaneous passage and may be managed with hydration and analgesia; serial plain radiographs may be obtained to document stone passage. Most other patients require noncontrast CT for accurate diagnosis and treatment. Treatment choices include SWL, uteroscopy, and percutaneous nephrolithotomy, and their success depends on the stone size and location within the proximal or distal ureter.