Urolithiasis

[ASM student]

I'm confused here, both in step up 2 medicine and my school ( as far as I remember) said that KUB X-ray is the best initial test but in uworld it's said that either spiral CT or U/S is the imaging of choice, so who's right?!!!!

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[natg101]

Best initial vs test of choice are different things..


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[ASM student]

The question stem gives a history suggestive of renal colic then asks about best next step to take.

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[vm26]

The question stem gives a history suggestive of renal colic then asks about best next step to take.

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Real world answer is CT (KUB cannot differentiate a non-obstructive pelvic calculus versus an obstructing calculus at the level of the UPJ or an obstructing distal ureteral calculus versus a calcified pelvic phlebolith)...US can detect hydro and renal calculi but more than likely will not pick up an obstructing ureteral calculus unless very proximal or distal...KUB is good to follow known calculi, particularly after lithotripsy

 

[ASM student]

This was the explanation written in uworld but I've always thought that KUB is preferred as it's cheaper then a CT can be ordered if negative KUB is combined with highly suggestive clinical picture, but I've looked it up and it seems that uworld is correct.
Check this from AAFP

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