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LETTER TO THE EDITOR |
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| Year : 2012 | Volume
: 8
| Issue : 1 | Page : 25-26 |
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Imaging in ureteric stones
Arvind P Ganpule
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| Date of Web Publication | 13-Jan-2012 |
Correspondence Address:
Arvind P Ganpule
Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.91782
How to cite this article:
Ganpule AP. Imaging in ureteric stones. J Min Access Surg 2012;8:25-6 |
Dear Sir,
I read with great interest the article by Huri et al. [1] in the latest issue of JMAS. The article, although interesting, raises a few pertinent questions regarding the management of a suspected ureteric calculus seen on plain x-ray. I would like to make a few points. A response from the authors would be useful.
First, it is known that one of the differential diagnoses of a radiopaque density in the renal region is a calcified aneurysm. The patient in this case had presented with flank pain and with appropriate investigations the reason for the flank pain could have been identified prior to any intervention.
Second, the order and choice of investigations are pivotal in clinching the diagnosis and preventing an untoward event. Such a 'large stone,' if present, will cause a significant amount of hydronephrosis and thinning of the cortex (if it was a long-standing obstruction), and this should be revealed with an ultrasound of the kidney, ureter, and the bladder. A skilled sonologist could have traced the stone even if it was situated in the upper ureter. The authors in the report do not mention the ultrasound findings in the article.
Third, although the authors mention that 'nonenhanced, stone-protocol, abdominopelvic spiral computed tomography (CT) was performed to evaluate the stone location,' the picture [Figure 1] depicts a conventional intravenous pyelogram. A picture of the CT scan would have been useful. It would have been very difficult to miss a aneurysm on one of the newer-generation multislice CT machines, particularly on a contrast study. The authors' comments in this regard would be useful.
Finally, if the intravenous pyelogram pictures [Figure 1] provided are closely studied, it can be noticed that the contrast in the left kidney is not seen draining into the ureter. This should be an indication to perform a retrograde pyelogram (RGP) prior to managing the stone either with a endourological, laparoscopic, or open approach. If the radiopaque density had been seen located lateral to the line of the ureter on the RGP, it would have warned the surgeon that something is amiss, and the intraoperative catastrophe could have been avoided.
In conclusion, this case report highlights the fact that systematic and appropriate imaging forms the cornerstone of the management of ureteric stones.
| ¤ References | |  |
| 1. | Huri E, Akgül T, Karakan T, Sargon M, Germiyanoðlu C. A very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy. J Minim Access Surg 2011;7:145-6. 
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