Hydronephrosis on Point-of-Care Ultrasound Linked to Higher Stone Detection and Urologic Intervention in Renal Colic Study
USA: Renal point-of-care ultrasound (rPOCUS) findings of hydronephrosis are strongly linked to the presence of kidney stones in adults presenting to the emergency department (ED) with suspected renal colic, a recent study has revealed. However, despite its diagnostic value, the use of rPOCUS does not appear to significantly reduce computed tomography (CT) utilization or shorten ED length of stay.
The study was conducted by Mark D. Scheatzle, Department of Emergency Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, and colleagues, and was published online in the Journal of Emergency Medicine.
Renal colic remains a frequent reason for ED visits, and imaging plays a central role in diagnosis and management. While CT scanning is considered the gold standard for detecting nephrolithiasis, it comes with drawbacks, including radiation exposure, increased healthcare costs, and the potential for incidental findings that may lead to unnecessary follow-up tests. In contrast, rPOCUS offers a rapid, bedside, radiation-free alternative that can detect hydronephrosis, a key indicator of urinary obstruction.
To better understand the clinical and operational impact of rPOCUS, researchers conducted a retrospective cohort study involving 188 adult patients who underwent ultrasound evaluation for suspected renal colic between January 2020 and January 2022. Among them, 89 patients (47%) showed evidence of hydronephrosis, while 99 (53%) did not.
The following were the key findings:
- Hydronephrosis on ultrasound was associated with a higher likelihood of prior kidney stone history.
- Patients with hydronephrosis more frequently had a history of previous urologic procedures.
- Abnormal renal function was more commonly observed in patients with hydronephrosis.
- These patients were more likely to present with symptoms of shorter duration.
- Kidney stone–related complaints were more frequently reported in those with hydronephrosis.
- Hydronephrosis strongly predicted a final emergency department diagnosis of renal colic.
- CT imaging was performed in more than half of all patients.
- CT utilization was significantly higher in patients with hydronephrosis.
- Nearly three-quarters of patients with hydronephrosis underwent CT scans compared to less than half without it.
- Ultrasound findings of hydronephrosis were strongly associated with CT-confirmed ureteral stones.
- Detection rates of ureteral stones were substantially higher in patients with hydronephrosis.
- Hydronephrosis was linked to an increased likelihood of early urologic intervention.
- Around one in four patients with hydronephrosis required intervention within 24 hours.
- Early intervention rates were considerably lower in patients without hydronephrosis.
- Clinically significant alternative diagnoses were rare.
- Such alternative diagnoses were observed only in patients without hydronephrosis.
- The presence of hydronephrosis did not reduce emergency department length of stay.
- Average length of stay was similar regardless of ultrasound findings.
- Patients undergoing CT imaging had significantly longer emergency department stays.
- CT utilization emerged as a major factor contributing to prolonged emergency department time.
Overall, the findings suggest that while rPOCUS is effective in identifying patients with kidney stones and predicting the need for intervention, its potential to streamline ED workflow may be limited in current practice. Continued reliance on CT imaging, even when ultrasound findings are suggestive, appears to offset the operational benefits of bedside ultrasound.
Reference: https://www.jem-journal.com/article/S0736-4679(26)00122-8/abstract
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