Imaging in Stone Diagnosis and Surgical Planning

Emily C. Serrell; Sara L. Best


Curr Opin Urol. 2022;32(4):397-404. 

In This Article

Abstract and Introduction


Purpose of Review: Radiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning.

Recent Findings: The diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection.

Summary: The diagnosis and management of urolithiasis are increasingly personalized. Patient and stone characteristics will support clinicians in treatment decision, surgical planning, and counseling.


The overall incidence and prevalence of kidney stones have been increasing worldwide.[1,2] Consequently, there has been a significant increase in emergency department (ED) presentations for renal colic.[3] In the United States, renal colic is responsible for over two million ED visits annually,[4] putting it in the top ten diagnoses for ED evaluation.[3] This is associated with increased healthcare costs,[5,6] as well as acute and chronic morbidity for patients.[7,8]

Noncontrast computed tomography (CT) is accepted as the reference modality for the detection of urolithiasis with a reported sensitivity of 98% and specificity of 97%.[9] In the last three decades, the use of CT has more than tripled in acute evaluation of urolithiasis, from 21% to 71%. This has not been associated with a significant change in the number of admissions or interventions.[4] Thus, the diagnostic workup of flank pain has evolved to be potentially more costly as well as expose patients to more radiation. As such, it is essential for clinicians to understand the relative strengths and limitations of different imaging modalities.

In this review, we will summarize the most recent advances in the imaging of nephrolithiasis including efforts to reduce radiation exposure and identify factors pertinent for surgical planning.