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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:19-27 • 0278-4297

Value of 3-Dimensional Transrectal/ Transvaginal Sonography in Diagnosis of Distal Ureteral Calculi

Michael Mitterberger, MD, Germar Michael Pinggera, MD, Elisabeth Maier, Hannes Neuwirt, MD, Richard Neururer, MD, Leo Pallwein, MD, Johannes Gradl, MD, Georg Bartsch, MD, Hannes Strasser, MD and Ferdinand Frauscher, MD

Departments of Urology (M.M., G.M.P., E.M., H.N., R.N., G.B., H.S.) and Radiology II (L.P., J.G., F.F.), Medical University of Innsbruck, Innsbruck, Austria.

Address correspondence to Michael Mitterberger, MD, Department of Urology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. E-mail: michael.mitterberger{at}uibk.ac.at

Objective. In a prospective study, the feasibility of 3-dimensional (3D) transrectal/transvaginal sonography in comparison with transabdominal sonography and intravenous urography (IVU) in identifying distal ureteral calculi was evaluated. Methods. Sixty-two patients in the urologic clinic with clinical suspicion of distal ureteral calculi were included. The patients consisted of 44 men and 18 women with a mean age ± SD of 44 ± 17 years. These patients underwent 3D transrectal/transvaginal sonography, transabdominal sonography with IVU, and, finally, ureterorenoscopy. Results. Fifty-nine patients were confirmed to have distal ureteral calculi on the basis of urologic intervention (ureterorenoscopy). Three patients had a spontaneous stone passage immediately after imaging completion. The median size of the calculi was 3.7 ± 2.00 mm. Transabdominal sonography detected 34 of the 62 patients with calculi (sensitivity, 55%). The median size of the calculi was calculated as 5.0 ± 2.4 mm. The examination time was 6.5 ± 2.7 minutes. Intravenous urography detected 44 of the 62 patients with ureterolithiasis (sensitivity, 71%). Herein, the median stone size was measured as 3.9 ± 1.9 mm, and the examination time was 38 ± 17 minutes. The combination of transabdominal sonography and IVU in visualization of ureterolithiasis raised the sensitivity to 81% (50 of 62 patients). Three-dimensional transrectal/transvaginal sonography showed ureterolithiasis in all 62 patients confirmed to have distal ureteral calculi (sensitivity and specificity, 100%). The median size of the calculi was calculated as 4.4 ± 2.2 mm, and the examination took 1.9 ± 0.6 minutes. Conclusions. The data in our prospective study show that transrectal/transvaginal sonography with 3D image assessment is superior to IVU and abdominal sonography for diagnosing distal ureteral calculi.

Key Words: 3-dimensional transrectal/transvaginal sonography • 2-dimensional abdominal sonography • ureteral calculi

Abbreviations: CT, computed tomography • IVU, intravenous urography • 3D, 3-dimensional • 2D, 2-dimensional • URS, ureterorenoscopy

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.