Optimising Imaging Strategies in Suspected Urolithiasis: Effects on Diagnostic and Therapeutic Timelines

Background: Prompt imaging is essential in the diagnosis and management of urinary stone disease. While international guidelines recommend ultrasonography (US) as the first-line modality due to its safety and accessibility, delays in imaging and treatment are common in overcrowded healthcare systems. This study aimed to compare the clinical timelines and outcomes of patients undergoing initial US versus direct non-contrast computed tomography (NCCT). Materials and Methods: This retrospective study included 120 adult patients who presented to the urology department of a tertiary care hospital in Türkiye with suspected urinary stone disease. Patients were categorised based on their initial imaging modality. Time intervals from admission to imaging and from admission to definitive treatment were recorded. Treatment rates and return visits were also evaluated. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of treatment. Results: The median time to initial imaging and to definitive treatment was significantly shorter in patients who underwent direct NCCT compared to those who underwent initial US (4 vs. 10 days and 15 vs. 33.5 days, respectively; p < 0.001 for both). Multivariate analysis showed that longer imaging delays were independently associated with reduced odds of receiving treatment (OR: 0.859; 95% CI: 0.770–0.958; p = 0.006). ROC analysis demonstrated moderate predictive performance (AUC = 0.658). Conclusions: In resource-limited, high-volume settings, US may lead to diagnostic and therapeutic delays despite guideline recommendations. Direct low-dose NCCT may offer a more efficient alterna-tive without significantly increasing radiation exposure or cost. Imaging strategies should be tailored to local healthcare realities to ensure timely management of stone disease.