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Objective <p>Urolithiasis is a common urological condition accounting for more than 1.3 million emergency department visits annually with costs exceeding $2.8 billion (Scales et al. in Eur Urol. 62:160–5, 2012;Eaton et al. in J Endourol 27:1535–1538, 2013;Antonelli et al. in Eur Urol 66:724–729, 2014;). Non-contrast computed tomography of the abdomen and pelvis remains the diagnostic gold standard. Studies assessing urinalysis and renal point-of-care ultrasound (PoCUS), individually, to diagnose symptomatic ureterolithiasis demonstrate inadequate sensitivities (Mefford et al. in West J Emerg Med 18:775, 2017;Eray et al. in Am J Emerg Med 21:152–4, 2003;Luchs et al. in Urology 59:839–842, 2002;Smith-Bindman et al. in N Engl J Med 371:1100–1110, 2014;Riddell et al. in West J Emerg Med 15:96–100, 2014;Rosen et al. in J Emerg Med 16:865–870, 1998;Gaspari and Horst in Acad Emerg Med 12:1180–1184, 2005;Watkins et al. in Emerg Med Australas 19:188–195, 2007;). The primary objective of this study was to assess the test characteristics of the U-PoCUS (urinalysis with renal point-of-care ultrasound) protocol.</p> Methods <p>This was an Institutional Review Board approved, multi-center, retrospective chart review at a university-based healthcare system. Study investigators included all patients who presented from January 1, 2016 through June 30, 2020, and underwent computed tomography of the abdomen and pelvis and had a urinalysis and PoCUS for suspected ureterolithiasis. Investigators utilized MedCalc (Version 19.1.6) and standard 2 × 2 tables to calculate test characteristics with 95% confidence intervals (CI).</p> Results <p>Study investigators enrolled 183 patients, including 122 patients diagnosed with computed tomography confirmed ureterolithiasis and 61 patients without it. The combination of hematuria and/or hydronephrosis on PoCUS had a sensitivity of 99.2% (95.6–100) and a specificity of 14.8% (7–26.2) for the presence of urolithiasis. Positive predictive value and negative predictive value were 69.9% (67.7–72.1) and 90% (53.9–98.6), respectively.</p> Conclusion <p>The presence of hematuria and/or hydronephrosis was 99.2% sensitive for the presence of ureterolithiasis diagnosed on computed tomography of the abdomen and pelvis. The U-PoCUS protocol missed only one symptomatic ureterolithiasis.</p>

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The U-POCUS protocol: urinalysis and point-of-care ultrasound to exclude symptomatic ureterolithiasis in emergency department patients

  • 期刊论文

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  • 发表日期：

    2025年9月13日

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  • Matthew Tripod,
  • Kendra Mendez,
  • Matthew Berger,
  • Claire Shaffer,
  • Timothy Yeung,
  • Thomas G. Costantino,
  • Steven Peterson,
  • Ryan C. Gibbons

摘要

Objective

Urolithiasis is a common urological condition accounting for more than 1.3 million emergency department visits annually with costs exceeding $2.8 billion (Scales et al. in Eur Urol. 62:160–5, 2012;Eaton et al. in J Endourol 27:1535–1538, 2013;Antonelli et al. in Eur Urol 66:724–729, 2014;). Non-contrast computed tomography of the abdomen and pelvis remains the diagnostic gold standard. Studies assessing urinalysis and renal point-of-care ultrasound (PoCUS), individually, to diagnose symptomatic ureterolithiasis demonstrate inadequate sensitivities (Mefford et al. in West J Emerg Med 18:775, 2017;Eray et al. in Am J Emerg Med 21:152–4, 2003;Luchs et al. in Urology 59:839–842, 2002;Smith-Bindman et al. in N Engl J Med 371:1100–1110, 2014;Riddell et al. in West J Emerg Med 15:96–100, 2014;Rosen et al. in J Emerg Med 16:865–870, 1998;Gaspari and Horst in Acad Emerg Med 12:1180–1184, 2005;Watkins et al. in Emerg Med Australas 19:188–195, 2007;). The primary objective of this study was to assess the test characteristics of the U-PoCUS (urinalysis with renal point-of-care ultrasound) protocol.

Methods

This was an Institutional Review Board approved, multi-center, retrospective chart review at a university-based healthcare system. Study investigators included all patients who presented from January 1, 2016 through June 30, 2020, and underwent computed tomography of the abdomen and pelvis and had a urinalysis and PoCUS for suspected ureterolithiasis. Investigators utilized MedCalc (Version 19.1.6) and standard 2 × 2 tables to calculate test characteristics with 95% confidence intervals (CI).

Results

Study investigators enrolled 183 patients, including 122 patients diagnosed with computed tomography confirmed ureterolithiasis and 61 patients without it. The combination of hematuria and/or hydronephrosis on PoCUS had a sensitivity of 99.2% (95.6–100) and a specificity of 14.8% (7–26.2) for the presence of urolithiasis. Positive predictive value and negative predictive value were 69.9% (67.7–72.1) and 90% (53.9–98.6), respectively.

Conclusion

The presence of hematuria and/or hydronephrosis was 99.2% sensitive for the presence of ureterolithiasis diagnosed on computed tomography of the abdomen and pelvis. The U-PoCUS protocol missed only one symptomatic ureterolithiasis.