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The purpose of this study was to assess the efficacy of model-based iterative reconstruction (MBIR), statistical iterative reconstruction (SIR), and filtered back projection (FBP) image reconstruction algorithms in the delineation of ureters and overall image quality on non-enhanced computed tomography of the renal tracts (NECT-KUB). This was a prospective study of 40 adult patients who underwent NECT-KUB for investigation of ureteric colic. Images were reconstructed using FBP, SIR, and MBIR techniques and individually and randomly assessed by two blinded radiologists. Parameters measured were overall image quality, presence of ureteric calculus, presence of hydronephrosis or hydroureters, image quality of each ureteric segment, total length of ureters unable to be visualized, attenuation values of image noise, and retroperitoneal fat content for each patient. There were no diagnostic discrepancies between image reconstruction modalities for urolithiasis. Overall image qualities and for each ureteric segment were superior using MBIR (67.5 % rated as 'Good to Excellent' vs. 25 % in SIR and 2.5 % in FBP). The lengths of non-visualized ureteric segments were shortest using MBIR (55.0 % measured 'less than 5 cm' vs. ASIR 33.8 % and FBP 10 %). MBIR was able to reduce overall image noise by up to 49.36 % over SIR and 71.02 % over FBP. MBIR technique improves overall image quality and visualization of ureters over FBP and SIR.

Introduction: Ureteral colic is a common painful disorder. Early surgical intervention is an attractive management option but existing evidence does not clarify which patients benefit. Based on lack of evidence, current national specialty guidelines provide conflicting recommendations regarding who is a candidate for early intervention. We compared treatment failure rates in patients receiving early intervention to those in patients offered spontaneous passage to identify subgroups that benefit from early intervention. Methods: We used administrative data and structured chart review to study consecutive patients attending one of nine hospitals in two provinces with an index emergency department (ED) visit and a confirmed 2.0-9.9 mm ureteral stone. We described patient, stone and treatment variables, and used multivariable regression to identify factors associated with treatment failure, defined as the need for rescue intervention or hospitalization within 60 days. Our secondary outcome was ED revisit rate. Results: Overall, 1168 (37.9%) of 3081 eligible patients underwent early intervention. Patients with small stones Conclusion: This study clarifies stone characteristics that identify patients likely to benefit from early intervention. We recommend low-risk patients with uncomplicated stones 5mm, or any stone >7mm, be offered early intervention.

Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.

Objective: To assess the accuracy and benefit of urgent bedside ultrasound scanning in urological emergencies by urology trainees. Methods: In this prospective study, 111 patients (86 acute flank pain, 15 renal failure, 10 haematuria) referred as urological emergencies, were scanned for urinary tract abnormalities at the bedside, by a trainee urologist, over 18 months. The ultrasound findings were compared with the results of imaging performed by a consultant radiologist and its influence on clinical management analysed. Results: Bedside ultrasound proved life saving in 5 patients (2 pyonephrosis, 2 leaking aneurysms, one bilateral ureteric injury). It significantly influenced management in 11 patients, excluded obstruction in the presence of infection in 13 patients, helped in early diagnosis in 32 patients and ruled out gross urological pathology in 28 patients. It was misleading in 22 patients, mainly with ureteric colic (where the timing of the test can affect the findings), though the outcome was not adversely affected in any. Bedside ultrasound was reasonably accurate (sensitivity 81% and specificity 92%). Conclusions: Bedside ultrasound is a useful tool to help the decision-making in urological emergencies and reasonably accurate in hands of a trainee urologist. It is especially helpful for excluding obstruction in presence of infection or renal failure. However it has inherent limitations in assessing acute ureteric colic.

A 69-year-old man with a history of medullary sponge kidney presented with left sided ureteric colic. An intravenous urogram (IVU) failed to adequately demonstrate the left lower pole calyces and therefore a retrograde examination was performed (Fig. 1). A filling defect within the pelvi-calyceal system was present throughout the fluoroscopic examination. Urine cytolog2r was reported as suspicious for malignancy. A CT confirmed the presence of a filling defect which was not a stone. A left nephroureterectomy was therefore performed.

A randomised prospective double-blind study of the effect of 1 mg glucagon intravenously was done on 51 consecutive patients with acute uretic colic. No significant difference between glucagon and placebo could be demonstrated as to pain relief or passage of calculi.