Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasonography of abdominal organs) – for basic diagnosis in adults, pregnant women, and children; also to exclude common differential diagnoses [sensitivity of ultrasonography (percentage of diseased patients in whom the disease is detected by use of the procedure, i.e., a positive finding occurs), especially in combination with calyx dilatation (calyx dilation) is up to 96% for kidney stones or ureteral stones (ureteral calculi) >5 mm; regarding Urinary stones: sensitivity (percentage of diseased patients in whom the disease is detected by the application of the procedure, ie a positive finding occurs) 60-90%, specificity (probability that actually healthy people who do not suffer from the disease in question, by the procedure are also detected as healthy) 84-100%; in ureteral stones sonographically is usually only the urinary congestion recognizable]
- Computed tomography (CT) of the abdomen (abdominal CT) as a native computed tomography (“non-contrast CT”, NCCT) – for suspected ureteral stones or for the exact localization of the stone in unclear findings [constant sensitivity regardless of stone size: calculi < 3 mm: about 96%; calculi > 3 mm: 96-100%; regarding. urinary stones: sensitivity 99 %, specificity 99 %; gold standard for imaging in known urinary stones or suspected urolithiasis]Low-dose CT can be performed in unclear cases, even in children.NCCT is increasingly replacing the i.v. pyelogram because it provides more information for differential diagnosis with comparable radiation exposure.Contrast imaging is required before interventional stone therapy. Note: The diameter of stones was estimated by abdominal ultrasonography on average 3.3 mm too large!
- Radiography of the abdomen/pelvis – for basic diagnosis for stone diagnosis, to determine the radiopacity and for follow-up of radiopaque calculi [Sensitivity is 44-77% and specificity is 80-87%; should be a thing of the past]In the first trimester (third trimester of pregnancy), radiography should be avoided.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Dual-energy technique (DECT); technique performed by simultaneous acquisition of two sets of CT data; examination with different X-ray energies allows more accurate tissue differentiation than before – for differentiation of uric acid and nonuric acid stones in vivo [sensitivity: 95.5%; specificity: 98.5%].
- Magnetic resonance imaging (MRI)-urography – plays no role in routine diagnosis of urinary stones; used primarily in children; also used in cases of contrast agent intolerance.
- I.v. pyelogram (synonyms: IVP; i.v. urogram; urogram; i.v. urography; excretory urography; excretory pyelogram; intravenous excretory urogram; radiographic representation of the urinary organs esp. of the hollow system morphology or the urinary draining system) – performance only in the colic-free interval, since the renal pelvic caliceal system could rupture due to contrast medium-induced diuresis (increased urine excretion) in acute colic! Note: A blank image already shows calcium-containing stones, as these are shadowing. [The sensitivity of excretory urography is between 51-87%, the specificity between 92-100%]An i.v. pyelogram can be performed in children for treatment planning.In the first trimester (third trimester of pregnancy), an X-ray examination should be omitted.
- Ante- or retrograde ureteropyelography (X-ray examination using a contrast medium to visualize the renal pelvis and ureters) – if an indication for urinary diversion has been made.
