There is a school of practice in which patients are evaluated for potential ureterolithiasis primarily by history, physical, and urinalysis. If the stars align, it’s ureterolithiasis. Simple.
But, how do you know? What if it isn’t? Then you have a misdiagnosis, diagnostic inertia, and the patient will obviously go wander off and expire somewhere inconvenient.
I fall into the minimalist category for advanced imaging, and I do quite prefer to manage ureterolithiasis with as little fuss as possible. So, an article like this one – clearly stating in the title the conclusion I want to hear – ought to be precisely my cup of tea.
But, it’s a retrospective chart review. And, over half of the 291 patients identified as having “flank pain” didn’t receive any documented imaging. And, finally, even though the ultimate conclusion addresses the benign outcomes of patients with suspected renal colic – any sort of follow-up occurred only if patients re-presented to the same ED. So, yes, based on initial evaluation, few patients required urologic intervention and no critical alternative diagnoses were on advanced imaging. But, beyond the initial visit, there’s simply completely inadequate capture of any downstream adverse outcomes. No vital records, no telephone contact – nothing.
Their title is still probably correct. However, their study design only weakly supports said conclusion.
“Young Patients with Suspected Uncomplicated Renal Colic are Unlikely to Have Dangerous Alternative Diagnoses or Need Emergent Intervention”
http://www.ncbi.nlm.nih.gov/pubmed/25834669
I had a patient with history of Ureterolithiasis present with "pain like my prior kidney stone" and hazy heme positive urine. After a dose of Toradol, a CT was performed and low and behold-AAA! Off to the trauma surgeons with Toradol on board-he loved that.
That's where, for all my prior kidney stone patients, do a fast abdominal US, look at the beans, check for hydro, check the aorta, check the gutters, say goodbye if everything's fine.