Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi?

Objective: To examine the clinical utility of noncontrast-enhanced computed tomography (NCCT) in pediatric patients with urolithiasis who progressed to surgery. Although NCCT is routine for the evaluation of adult patients with suspected urolithiasis, its routine use in the pediatric population is tempered by concern about radiation exposure. Methods: We conducted a retrospective chart review of all pediatric patients who had undergone surgery for urinary stones from 2003 to 2008 at our institution. The imaging modalities used, surgery type, stone composition, 24-hour urinalyses, and relevant predisposing conditions were characterized. Results: A total of 42 pediatric patients (24 males and 18 females) were treated during the 6-year period. The average age was 11.3 ± 5.3 years (range 2.7-25.4), and the most common treatment modalities were shock wave lithotripsy (28%) and ureteroscopy (22%). A discernible risk factor or cause of urolithiasis was absent in 21 patients (47%). A review of imaging studies found 38 with stones visible on ultrasonography and/or abdominal plain film. A total of 21 patients underwent NCCT, in addition to ultrasonography and/or abdominal plain film. Of these, only 5 patients required NCCT for the diagnosis or management of their stone. Conclusion: Nearly 90% of pediatric patients treated for symptomatic urolithiasis could have completed their evaluation and treatment without undergoing NCCT. For children who present with signs and symptoms suggesting urinary calculi, an initial evaluation and imaging with ultrasonography and abdominal plain film might suffice, avoiding the radiation of NCCT.