Abstract
Traditional urodynamics have poor correlation with urological symptoms. Ambulatory urodynamics may improve this correlation but the need for a transurethral catheter and the time-consuming nature of this examination limits its use. Therefore, the objective of this study was to develop a wireless real-time bladder pressure measurement device for repeated and prolonged-term measurement of bladder behavior in awake pigs. The Bladder Pill is an intravesical device with a pressure microsensor and a 3-dimensional inductive coupling coil for energy supply. A corresponding external coil provides wireless power transmission and real-time communication of bladder pressure data. To test the correlation between the pressure data measured by the device and by standard methods, we compared static water column pressures with this device and water-filled urodynamic catheter systems. In vivo assessment of awake voiding by the pill was done by introducing the bladder pill into the bladder of Göttingen minipigs. An air-charged urodynamic catheter was introduced transurethrally as control for pressure measurements. The optimal physical configuration of the pill was investigated to maximize the containment in the bladder. We used two versions of external signal receivers (one waistband and one rectangular frame) to test the optimal external signal capture. Next to that, we performed short-term and medium-term comparative pressure studies. The in vitro static pressure measurement demonstrated a mean difference of less than 1 cm H2O between the methods. The optimal design of the pill for maximal retainment in the bladder proved to be a pigtail configuration. The bending of the device during bladder contractions caused offset of 2.7 +/- 1.4 cm H2O (mean +/- SD) on the pressure measurements. The rectangular frame performed signal capture during 5 consecutive voids with a good correlation of the pressure measurements. The device can be inserted through the urethra and is retrieved using string or endoscopic extraction. In conclusion, wireless long-term measurement of bladder pressure is demonstrated and yields comparable results to current available catheter methods of measurement in a pig model.
Highlights
Bladder pressure is a key parameter measured in the objective assessment of lower urinary tract dysfunction. [1] In neurogenic bladder conditions, abnormal patterns of intravesical pressure are associated with increased risk for upper urinary tract damage and renal dysfunction. [2] In the condition of idiopathic overactive bladder syndrome, findings from urodynamic investigations have poor correlation with reported symptoms
Design considerations of the Bladder Pill accounted for suitability of later use in humans
In vitro static water column pressures measured by the Bladder Pill in combination with the waistband external device demonstrated agreement with fluid-filled transducers and aircharged catheters (ACC)
Summary
Bladder pressure is a key parameter measured in the objective assessment of lower urinary tract dysfunction. [1] In neurogenic bladder conditions, abnormal patterns of intravesical pressure are associated with increased risk for upper urinary tract damage and renal dysfunction. [2] In the condition of idiopathic overactive bladder syndrome, findings from urodynamic investigations have poor correlation with reported symptoms. Bladder pressure is a key parameter measured in the objective assessment of lower urinary tract dysfunction. [1] In neurogenic bladder conditions, abnormal patterns of intravesical pressure are associated with increased risk for upper urinary tract damage and renal dysfunction. [2] In the condition of idiopathic overactive bladder syndrome, findings from urodynamic investigations have poor correlation with reported symptoms. The longer duration of observation has increased detection of urodynamic abnormalities such as detrusor overactivity. The standard recommendation for bladder pressure monitoring is a urethral catheter connected to a fluid-filled external transducer. [1] Other mechanisms are air-filled catheters and microtip sensors, with limitations specific to each catheter type. [10] common inconveniences to all catheter types are the limited observation time and subject awareness of the measuring instrument. Other problems in common with catheters are the insertion methods and intravesical retainment mechanism
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