The Limitations Of Ultrasound In Stone Disease

It is worth considering that ultrasound has a limited role in proper diagnosis and comprehensive management of stone disease. Its limitations include,

• It is operative dependent. The operator may be a qualified Sonologist, who picks up the exact relevant findings, a trainee or a mere quack, which only knows about the measurement of stone, without knowing its significance. In Pakistan, unqualified USG operators are available in most of streets and areas, and provide wrong reports, which misguide the patients as well as physician, showing highly non professional approach.
• It is machine dependent. USG is refined resolution of tissues and high tech; better machines provide better details of tissues. Mostly, the so called street quacks, keep poor quality machines with resultant poor results and poor interpretation.
• It is patient dependent. The quality of details in obese patients is poor as compared to thin lean patient. Patient’s preparation also carries significance. Full stomach, empty bladder, lot of gases and distention of abdomen suppress the findings.
• USG doesn’t cover the whole urinary tract. It doesn’t usually cover the mid n lower ureteral areas due to spine, intestines and gases in abdomen, especially when ureters are not dilated and patient is un- prepared. Similarly, stones in urethra are not traceable on USG, especially if lie distal to prostate.
• Actually, the stone measurements are three dimensional, but USG report usually narrates single dimension, which is misleading in oval, date shape or irregular, branched stones, which spread extensively in all the calyces.
• So, starting stone treatment, depending on mere findings of ultrasound can sometimes prove detrimental to health.