Download Journal Club Ureteral Stones with US

Journal Club
1. Name of topic:
 “Detection of Ureteral Stones with Transvaginal Sonography”
2. Who published the article?
 Carolina Vega in the Journal of Diagnostic Medical Sonography
3. Brief synopsis of article:
 Urolithiasis - a condition where mineral and acid salts form stones in the urinary
system
 Leading mineral in Urolithiassis formation is calcium
 Certain foods cause kidney stones
o High-protein diets
o High-salt diets
 More common in Caucasian people and in men than in women
 Several risk factors affect women
o Medications
o Pregnancy
o Underlying diseases
o Urinary tract infections
 Transvaginal Sonography is commonly the chosen method to detect stones
 It detects ureterolithiasis much easier than transabdominal sonography
 Transvaginal sonography uses higher frequencies
 The transducer is closer to the ureter
 It can assess ureteral calculi and pelvic abnormalities in one exam
Case Study:
 Woman
 Early twenties
 Persistent right lower quadrant pain
 Patient felt “achy” and experienced cramps
 Appendicitis was suspected
 Sonogram of the right lower quadrant was ordered
 12 MHz linear transducer was used on a Philips iU22 ultrasound machine
Results:
 No inflamed appendix
 Dilated distal right ureter
 Pelvic sonogram ordered
Results
 Found nothing
Transabdominal and Transvaginal scans done using 5 MHz curvilinear transducer
 There was a posterior acoustic shadowing and color Doppler twinkle artifact which
means stones
 Stone was measured in sagittal and transverse
 Stone: 4mm long and 3 mm wide
 Sonogram was very clear; did not require extra imaging
 Diagnosis: ureteral stone with hydroureter
 Because of the stones small size it was expected to pass on its own
 Patient was sent home and told to drink a lot of fluids
 Patient returned to emergency room less than a week later complaining of the same
right lower quadrant pain
 Renal sonogram ordered
 Showed moderate hydronephrosis in the right kidney
 Moderate dilation of right ureter
 Stone was seen in the distal ureter; transabdominally
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Transvaginal and transabdominal sonograms served as appropriate exams in order
to evaluate the patient’s condition.
Transvaginal sonogram was specifically able to reveal that the stone in the right
ureter was the cause of the pelvic pain.
Any stone smaller than 5 mm in width is able to be passed down the urinary tract to
relieve pain in lower abdominal region.
Two commonly used procedures to remove stones include:
1. Extracorporeal Shock Wave Lithotripsy (ESWL)
o Most common for kidney stone treatments
o Ultra-intensity US waves that decompose or break the stones in smaller
pieces which could then be removed via urinary tract
2. Percutaneous Nephrolithotomy (PNL)
o Surgical incision into the affected area to remove the stone
o High chance of good prognosis and efficiency
3. Conclusion of article:
 Stones are likely to reoccur in patients who have medical histories with stones in
the pelvic/lower abdominal region.
 Overall significance of the finding is that a transvaginal sonogram was most effective
to quickly locate and help diagnose a stone in the right ureter.
 No harm was done to the patient during examination procedure; sonogram did not
expose patient to RT (radiation therapy) and was able to help patient understand
the cause of right lower regional pain and the treatment necessary.