Cost-benefit of renal ultrasound in low back pain presenting to a urology outpatient clinic: A retrospective study of 126 cases

Background: Low back pain is a frequent complaint in urology outpatient consultations. While renal ultrasonography is widely used as a first-line imaging modality, its systematic application regardless of clinical context raises questions of cost-effectiveness. The actual proportion of urological causes among all low back pain presentations remains poorly documented in North African settings.
Methods: A retrospective single-center observational study was conducted at the Department of Urology, Mohammed VI University Hospital, Tangier, Morocco, between January 2020 and March 2022. All consecutive patients consulting for low back pain were included. Demographic data, associated symptoms, laterality, and ultrasonographic findings were collected and analyzed.
Results: A total of 126 patients were included. The sex-ratio was 0.8 (female predominance, 55.6%). The mean age was 49 years. Right-sided pain predominated (43.6%), followed by bilateral (29.3%) and left-sided pain (26.9%). Associated urinary symptoms were the most frequent finding (24.6%), ahead of digestive (6.3%), neurological (7.9%), and osteoarticular causes (3.9%). Renal ultrasound was performed in all patients and was clinically significant in 34.9% of cases.
Conclusion: Urological causes account for only one-third of low back pain presentations in a urology outpatient setting. Systematic renal ultrasonography without prior clinical selection yields a low diagnostic return (34.9%) and may be reserved for patients with associated urinary symptoms. A thorough history and physical examination remain the cornerstone for selecting patients who will benefit from imaging.