Bladder Deformation Research Articles

Effects of bladder shape on accuracy of measurement of bladder volume using portable ultrasound scanner and development of correction method.

To compare the accuracy of using a bladder scanner to measure bladder volume through intermittent catheterization (IC) in patients and to introduce the Bladder Deformation Index (BDI) to develop a correction method. Bladder volume was assessed by a nurse with the scanner. A second nurse catheterized the patient's bladder. A third nurse measured the urine volume in a 500-mL or 1000-mL graduated cylinder. Sixty one patients were included and 590 pairs of data were obtained. The mean bladder volume measured using a scanner and IC was (332.3 ± 156.1) mL and (339.1 ± 158.8) mL. The mean absolute difference was 30.8 mL. The correlation coefficient was 0.929. Patients were classified into 2 groups depending on whether they had undergone augmentation cystoplasty. The mean absolute difference was 109.2 and 20.4 mL. The correlation coefficient was 0.712 and 0.981. According to the BDI, bladders can be classified into 3 groups. The mean absolute difference was 21.9, 60.4, and 109.4 mL. The correlation coefficient was 0.970, 0.839, and 0.783. The linear regression equations of Grade I and Grade II were Y = 1.11X + 3.1 and Y = 0.76X + 161.5. The results showed that bladder shape plays a critical role in accuracy which is inversely associated with BDI. This degree of accuracy is sufficient; especially measurement adjusted using the linear regression equation in patients with high BDI. However, although the preliminary results of the study are promising, a large-scale prospective study should be needed to address the validation of the data in the future.

Internal Morphological Effects of Growth Hormone Transgenesis in Coho Salmon

AbstractEffects of growth hormone (GH) overexpression on internal morphology were examined in homozygous and hemizygous GH transgenic Coho Salmon Oncorhynchus kisutch aided by clearing and staining and magnetic resonance imaging methodologies. Morphological effects of transgenesis were observed in pin bones in fast‐growing hemizygous transgenic salmon, in vertebral column and swim bladder deformities in homozygotes, and as nonproportional modifications to some cranial structures examined among groups. These data provide further examples of the complex pleiotropic effects arising from GH overexpression in transgenic salmon.

Schistosomiasis: Review of an immune complex disease

BACKGROUND: Morbidity due to human schistosomiasis is associated with host immune responses which result in immune based inflammation, granuloma formation and fibrotic lesions.
 MATERIALS AND METHODS: This is a review of the literature on the immunology of schistosomiasis and the description of the immunopathogenesis of the disease. Relevant articles were retrieved using electronic search and hand search of published literature.
 RESULTS: Host responses which include immune based inflammation, granuloma formation and fibrotic lesions are aimed at destroying schistosome ova lodged in the liver, intestinal and bladder walls, and other tissues. At the site of the infection, ‘swimmers’ itch is due to physical damage to the skin by proteases and other toxic substances secreted by cercaria. During intestinal Schistosomiasis, the parasitic ova are lodged in the liver provoking fibrogenesis, while during urinary schistosomiasis pathology is attributed to the formation of granuloma along the urinary tract, there is fibrosis which lead to strictures, calcification and urodynamic abnormalities. The classic descriptions of schistosomiasis-related morbidity focus on pathologies unique to schistosome infection: periportal fibrosis for intestinal schistosomiasis and bladder deformity and hydronephrosis for urogenital schistosomiasis.
 CONCLUSION: This review provides some useful information concerning some aspects of the relationships between Schistosoma species and the human host.

Analyzing the effects of instillation volume on intravesical delivery using biphasic solute transport in a deformable geometry.

Ailments of the bladder are often treated via intravesical delivery-direct application of therapeutic into the bladder through a catheter. This technique is employed hundreds of thousands of times every year, but protocol development has largely been limited to empirical determination. Furthermore, the numerical analyses of intravesical delivery performed to date have been restricted to static geometries and have not accounted for bladder deformation. This study uses a finite element analysis approach with biphasic solute transport to investigate several parameters pertinent to intravesical delivery including solute concentration, solute transport properties and instillation volume. The volume of instillation was found to have a substantial impact on the exposure of solute to the deeper muscle layers of the bladder, which are typically more difficult to reach. Indeed, increasing the instillation volume from 50-100 ml raised the muscle solute exposure as a percentage of overall bladder exposure from 60-70% with higher levels achieved for larger instillation volumes. Similar increases were not seen for changes in solute concentration or solute transport properties. These results indicate the role that instillation volume may play in targeting particular layers of the bladder during an intravesical delivery.

Early Experiences of Contact Laser Vaporization of the Prostate using the 980 nm High Power Diode Laser for Benign Prostatic Hyperplasia.

We report early experiences of contact laser vaporization of the prostate for symptomatic benign prostatic hyperplasia (BPH). A total of 80 patients recruited at four institutions in Japan from April 2013 through September 2014 underwent contact laser vaporization of the prostate using 980 nm high power diode laser with an end-firing fiber in the contact mode. Patients were followed prospectively at 1 day, 2, 4, 8, 12, and 24 weeks, postoperatively per protocol, and at 1 and 2 years post-protocol. Of 76 eligible patients, 64 (84.2%) achieved more than 50% decrease in International Prostate Symptom Score at 24 weeks (95% confidence interval: 74.0-91.6%), clearing the pre-fixed non-inferiority efficacy level to transurethral resection of the prostate (65%). Symptom scores, maximum flow rate, post-void residual urine, and prostate volume showed significant improvements at 12 and 24 weeks after the surgery. Perioperative complications included transient urinary retention (n = 20), retrograde ejaculation (5), bladder neck contracture (4), urethral stricture (3), stone in prostatic bed (3), bladder stone (2), bladder perforation (1), bladder deformity (1), and transient urgency incontinence (1). Urinary retention and bladder neck contracture occurred almost exclusively at one institution. Improved symptom scores, maximum flow rate, and post-void residual urine observed at 24 weeks remained virtually unchanged at 1 and 2 years. Early experience of contact laser vaporization in Japan showed efficacy comparable to transurethral resection of the prostate as a surgical procedure for BPH at 24 weeks. Long-term efficacy of the procedure remains uncertain.

Three-dimensional mechano-electrochemical model for smooth muscle contraction of the urinary bladder

The urinary bladder is a central organ of vertebrates and imposes, based on its extreme deformation (volume changes up to several 100%), special requirements on the overall bladder tissue. However, studies focusing on three-dimensional modelling of bladder deformation and bladder function during micturition are rare. Based on three fields, namely, the membrane potential, calcium concentration, and placement, a mechano-electrochemical-coupled, three-dimensional model describing the contractile behaviour of urinary bladder smooth muscle is presented using a strain energy function. The strain energy functions for the different layers of the bladder wall are additively decomposed into a passive part comprising elastin, the extracellular matrix (ECM), and collagen and an active electrochemical-driven part comprising the contraction of smooth muscle cells (SMC). While the two-variable FitzHugh-Nagumo-type membrane model (FitzHugh, 1961; Nagumo et al., 1962) has been used to describe the membrane potential characteristics, the four-state, cross-bridge model of Hai and Murphy (1988) is implemented into the finite element method for the quantification of the calcium phase. Appropriate model parameters were determined experimentally using 40 tissue strips isolated from porcine bladders. Characteristic orientation-dependent passive and active stress-stretch relationships were identified for muscle strips, including the entire bladder wall structure and those featuring the isolated muscle layer only. Active experiments on the smooth muscle layers revealed higher stresses in the longitudinal (28.9kPa) direction than in the transversal (22.7kPa) one. Additionally, three-dimensional deformation characteristics were recorded from single muscle strips to qualitatively confirm the strip simulations. Three-dimensional simulations at the tissue strip level and the organ level were performed to analyse the interaction among the electrical action potential, calcium distribution, chemical degree of activation, and equivalent von Mises stress.

Population model of bladder motion and deformation based on dominant eigenmodes and mixed-effects models in prostate cancer radiotherapy.

In radiotherapy for prostate cancer irradiation of neighboring organs at risk may lead to undesirable side-effects. Given this setting, the bladder presents the largest inter-fraction shape variations hampering the computation of the actual delivered dose vs. planned dose. This paper proposes a population model, based on longitudinal data, able to estimate the probability of bladder presence during treatment, using only the planning computed tomography (CT) scan as input information. As in previously-proposed principal component analysis (PCA) population-based models, we have used the data to obtain the dominant eigenmodes that describe bladder geometric variations between fractions. However, we have used a longitudinal analysis along each mode in order to properly characterize patient's variance from the total population variance. We have proposed is a mixed-effects (ME) model in order to separate intra- and inter-patient variability, in an effort to control confounding cohort effects. Other than using PCA, bladder shapes are represented by using spherical harmonics (SPHARM) that additionally enables data compression without information lost. Based on training data from repeated CT scans, the ME model was thus implemented following dimensionality reduction by means of SPHARM and PCA. We have evaluated the model in a leave-one-out cross validation framework on the training data but also using independent data. Probability maps (PMs) were thus generated with several draws from the learnt model as predicted regions where the bladder will likely move and deform. These PMs were compared with the actual regions using metrics based on mutual information distance and misestimated voxels. The prediction was also compared with two previous population PCA-based models. The proposed model was able to reduce the uncertainties in the estimation of the probable region of bladder motion and deformation. This model can thus be used for tailoring radiotherapy treatments.

Characterization of Bladder Motion and Deformation in Prostate Cancer Radiotherapy

Objectives: In radiotherapy for prostate cancer the pelvic organs move and deform between fractions introducing geometrical uncertainties that make difficult to determine the delivered dose to healthy organs. This paper proposes a population model based on principal component analysis (PCA) to describe bladder motion and deformation between fractions by determining directions of geometric variability.Materials and Methods: This study included a cohort of 20 patients treated for prostate cancer with external beam radiotherapy. For each patient a planning CT scan and several (ranging from 5 to 8) on-treatment CT scans were available. 17 patients were used to obtain directions of bladder motion and deformation called modes using PCA, and the three remaining patients were used for validation. Dominant modes were used to characterize bladder shapes and motion/deformation regions in the latent space. The modes were evaluated using a reconstruction error in both PCA model and left-out patients.Results: A dimensionality reduction was obtained by representing any bladder in term of 104 scores instead of 1596375 voxel variables. 28 modes were considered as population directions to model bladder geometric variations.Conclusions: A population-based PCA model was implemented to quantify uncertainties produced by bladder motion and deformation between fractions in prostate cancer radiotherapy. This model can be used to quantify uncertainties in dose delivering and tailoring of personalized radiotherapy treatments.

Planned versus ‘delivered’ bladder dose reconstructed using solid and hollow organ models during prostate cancer IMRT

Background and purposeAll studies to date have evaluated the dosimetric effect of bladder deformation using an organ model that includes the dose to the urine. This research reconstructed bladder dose using both hollow and solid organ models, to determine if dose/volume differences exist. Materials and methods35 prostate IMRT patients were selected, who had received 78Gy in 39 fractions and full bladder instructions. Biomechanical modelling and finite element analysis were used to reconstruct bladder dose (solid and hollow organ model) using every third CBCT throughout the treatment course. ResultsReconstructed dose (ReconDose) was 11.3Gy greater than planned dose (planDose) with a hollow bladder model (p<0.001) and 12.3Gy greater with a solid bladder model (p<0.0001). Median reconstructed volumes within the 30Gy, 65Gy and 78Gy isodoses were 3–4 times larger with the solid organ model (p<0.0001). The difference between planning bladder volume and median treatment volume was associated with the difference between the planDose and reconDose below 78Gy (R2>0.61). ConclusionsSubstantial differences exist between planned and reconstructed bladder dose, associated with the differences in bladder filling between planning and treatment. Dose reconstructed using a solid bladder model over-reports the volume of bladder within key isodose levels and overestimates the differences between planned and reconstructed dose. Dose reconstruction with a hollow organ model is recommended if the goal is to associate that dose with toxicity.

A non-rigid point matching method with local topology preservation for accurate bladder dose summation in high dose rate cervical brachytherapy

GEC-ESTRO guidelines for high dose rate cervical brachytherapy advocate the reporting of the D2cc (the minimum dose received by the maximally exposed 2cc volume) to organs at risk. Due to large interfractional organ motion, reporting of accurate cumulative D2cc over a multifractional course is a non-trivial task requiring deformable image registration and deformable dose summation. To efficiently and accurately describe the point-to-point correspondence of the bladder wall over all treatment fractions while preserving local topologies, we propose a novel graphic processing unit (GPU)-based non-rigid point matching algorithm. This is achieved by introducing local anatomic information into the iterative update of correspondence matrix computation in the ‘thin plate splines-robust point matching’ (TPS-RPM) scheme. The performance of the GPU-based TPS-RPM with local topology preservation algorithm (TPS-RPM-LTP) was evaluated using four numerically simulated synthetic bladders having known deformations, a custom-made porcine bladder phantom embedded with twenty one fiducial markers, and 29 fractional computed tomography (CT) images from seven cervical cancer patients. Results show that TPS-RPM-LTP achieved excellent geometric accuracy with landmark residual distance error (RDE) of 0.7 ± 0.3 mm for the numerical synthetic data with different scales of bladder deformation and structure complexity, and 3.7 ± 1.8 mm and 1.6 ± 0.8 mm for the porcine bladder phantom with large and small deformation, respectively. The RDE accuracy of the urethral orifice landmarks in patient bladders was 3.7 ± 2.1 mm. When compared to the original TPS-RPM, the TPS-RPM-LTP improved landmark matching by reducing landmark RDE by 50 ± 19%, 37 ± 11% and 28 ± 11% for the synthetic, porcine phantom and the patient bladders, respectively. This was achieved with a computational time of less than 15 s in all cases with GPU acceleration. The efficiency and accuracy shown with the TPS-RPM-LTP indicate that it is a practical and promising tool for bladder dose summation in adaptive cervical cancer brachytherapy.

Hourglass bladder after ileocystoplasty (case report).

Narrowing of the anastomotic area between the bowel segment and urinary bladder is known as “hour-glass bladder.” This report describes a rare case of hourglass bladder deformity occurring post-ileocystoplasty in a 14-year-old male. We describe the essential steps that should be taken during bladder augmentation to avoid such a complication, along with a discussion of the relevant literature. This case emphasizes the need to strictly adhere to the steps of augmentation cystoplasty to avoid this technical complication.

α-Information-Based Registration of Dynamic Scans for Magnetic Resonance Cystography.

To continue our effort on developing magnetic resonance (MR) cystography, we introduce a novel nonrigid 3-D registration method to compensate for bladder wall motion and deformation in dynamic MR scans, which are impaired by relatively low signal-to-noise ratio in each time frame. The registration method is developed on the similarity measure of α-information, which has the potential of achieving higher registration accuracy than the commonly used mutual information (MI) measure for either monomodality or multimodality image registration. The α-information metric was also demonstrated to be superior to both the mean squares and the cross-correlation metrics in multimodality scenarios. The proposed α-registration method was applied for bladder motion compensation via real patient studies, and its effect to the automatic and accurate segmentation of bladder wall was also evaluated. Compared with the prevailing MI-based image registration approach, the presented α-information-based registration was more effective to capture the bladder wall motion and deformation, which ensured the success of the following bladder wall segmentation to achieve the goal of evaluating the entire bladder wall for detection and diagnosis of abnormality.

Real-Time Gall Bladder Motion and Deformation During Fractionated Stereotactic Body Radiation Therapy

Real-Time Gall Bladder Motion and Deformation During Fractionated Stereotactic Body Radiation Therapy

Masking Enhances Accuracy of Bladder Deformation in Multifraction Adaptive Brachytherapy as a First Step toward Composite Dose Estimation

GEC-ESTRO guidelines for cervix HDR brachytherapy advocate measurement of the 2cc dose received by organs at risk (OAR) and its summation across multiple treatment fractions to give a worst-case-scenario total cumulative dose estimate. If the OAR from different fractions could be accurately co-registered using deformation, then a more accurate composite dose could be obtained. As a first step toward composite dose estimation, we sought to assess and improve the quality of bladder deformation using a technique called masking, which involves resetting the pixel values within a contour.

Towards Accurate OAR Dose Accumulation in Cervix Brachytherapy: Applying a Non-Rigid Point Matching Method for Bladder Deformation

Towards Accurate OAR Dose Accumulation in Cervix Brachytherapy: Applying a Non-Rigid Point Matching Method for Bladder Deformation

Motion Correction for MR Cystography by an Image Processing Approach

Magnetic resonance (MR) cystography or MR-based virtual cystoscopy is a promising new technology to evaluate the entire bladder in a fully noninvasive manner. It requires the anatomical bladder images be acquired at high spatial resolution and with adequate signal-to-noise ratio (SNR). This often leads to a long-time scan (>5 min) and results in image artifacts due to involuntary bladder motion and deformation. In this paper, we investigated an image-processing approach to mitigate the problem of motion and deformation. Instead of a traditional single long-time scan, six repeated short-time scans (each of approximately 1 min) were acquired for the purpose of shifting bladder motion from intrascan into interscans. Then, the interscan motions were addressed by registering the short-time scans to a selected reference and finally forming a single average motion-corrected image. To evaluate the presented approach, three types of images were generated: 1) the motion-corrected image by registration and average of the short-time scans; 2) the directly averaged image of the short-time scans (without motion correction); and 3) the single image of the corresponding long-time scan. Six experts were asked to blindly score these images in terms of two important aspects: 1) the definition of the bladder wall and 2) the overall expression on the image quality. Statistical analysis on the scores suggested that the best result in both the aspects is achieved by the presented motion-corrected average. Furthermore, the superiority of the motion-corrected average over the other two is statistically significant by the measure of a linear mixed-effect model with p -values < 0.05. Our findings may facilitate the detection of bladder abnormality in MR cystography by mitigating the motion challenge. The effectiveness of this approach depends on the noise level of acquired short-time scans and the robustness of image registration, and future effort on these two aspects is needed.

Real-Time Bladder Lesion Registration and Navigation: A Phantom Study

BackgroundBladder cancer is the fourth most common malignancy in men, with a recurrence rate of 33–64%. Tumor documentation during cystoscopy of the bladder is suboptimal and might play a role in these high recurrence rates.ObjectiveIn this project, a bladder registration and navigation system was developed to improve bladder tumor documentation and consequently increase reproducibility of the cystoscopy.Materials/MethodsThe bladder registration and navigation system consists of a stereo-tracker that tracks the location of a newly developed target, which is attached to the endoscope during cystoscopy. With this information the urology registration and navigation software is able to register the 3D position of a lesion of interest. Simultaneously, the endoscopic image is captured in order to combine it with this 3D position. To enable navigation, navigational cues are displayed on the monitor, which subsequently direct the cystoscopist to the previously registered lesion. To test the system, a rigid and a flexible bladder phantom was developed. The system's robustness was tested by measuring the accuracy of registering and navigating the lesions. Different calibration procedures were compared. It was also tested whether system accuracy is limited by using a previously saved calibration, to avoid surgical delay due to calibration. Urological application was tested by comparing a rotational camera (fixed to the rotating endoscope) to a non-rotational camera (dangling by gravity) used in standard urologic practice. Finally, the influence of volume differences on registering and navigating was tested.Results/ConclusionThe bladder registration and navigation system has an acceptable accuracy for bladder lesion registration and navigation. Limitations for patient determinants included changes in bladder volume and bladder deformation. In vivo studies are required to measure the effect of these limitations and functionality in urological practice as a tool to increase reproducibility of the cystoscopy.

Control over structure-specific flexibility improves anatomical accuracy for point-based deformable registration in bladder cancer radiotherapy

Future developments in image guided adaptive radiotherapy (IGART) for bladder cancer require accurate deformable image registration techniques for the precise assessment of tumor and bladder motion and deformation that occur as a result of large bladder volume changes during the course of radiotherapy treatment. The aim was to employ an extended version of a point-based deformable registration algorithm that allows control over tissue-specific flexibility in combination with the authors' unique patient dataset, in order to overcome two major challenges of bladder cancer registration, i.e., the difficulty in accounting for the difference in flexibility between the bladder wall and tumor and the lack of visible anatomical landmarks for validation. The registration algorithm used in the current study is an extension of the symmetric-thin plate splines-robust point matching (S-TPS-RPM) algorithm, a symmetric feature-based registration method. The S-TPS-RPM algorithm has been previously extended to allow control over the degree of flexibility of different structures via a weight parameter. The extended weighted S-TPS-RPM algorithm was tested and validated on CT data (planning- and four to five repeat-CTs) of five urinary bladder cancer patients who received lipiodol injections before radiotherapy. The performance of the weighted S-TPS-RPM method, applied to bladder and tumor structures simultaneously, was compared with a previous version of the S-TPS-RPM algorithm applied to bladder wall structure alone and with a simultaneous nonweighted S-TPS-RPM registration of the bladder and tumor structures. Performance was assessed in terms of anatomical and geometric accuracy. The anatomical accuracy was calculated as the residual distance error (RDE) of the lipiodol markers and the geometric accuracy was determined by the surface distance, surface coverage, and inverse consistency errors. Optimal parameter values for the flexibility and bladder weight parameters were determined for the weighted S-TPS-RPM. The weighted S-TPS-RPM registration algorithm with optimal parameters significantly improved the anatomical accuracy as compared to S-TPS-RPM registration of the bladder alone and reduced the range of the anatomical errors by half as compared with the simultaneous nonweighted S-TPS-RPM registration of the bladder and tumor structures. The weighted algorithm reduced the RDE range of lipiodol markers from 0.9-14 mm after rigid bone match to 0.9-4.0 mm, compared to a range of 1.1-9.1 mm with S-TPS-RPM of bladder alone and 0.9-9.4 mm for simultaneous nonweighted registration. All registration methods resulted in good geometric accuracy on the bladder; average error values were all below 1.2 mm. The weighted S-TPS-RPM registration algorithm with additional weight parameter allowed indirect control over structure-specific flexibility in multistructure registrations of bladder and bladder tumor, enabling anatomically coherent registrations. The availability of an anatomically validated deformable registration method opens up the horizon for improvements in IGART for bladder cancer.

Automatic bladder segmentation on CBCT for multiple plan ART of bladder cancer using a patient-specific bladder model

In multiple plan adaptive radiotherapy (ART) strategies of bladder cancer, a library of plans corresponding to different bladder volumes is created based on images acquired in early treatment sessions. Subsequently, the plan for the smallest PTV safely covering the bladder on cone-beam CT (CBCT) is selected as the plan of the day. The aim of this study is to develop an automatic bladder segmentation approach suitable for CBCT scans and test its ability to select the appropriate plan from the library of plans for such an ART procedure. Twenty-three bladder cancer patients with a planning CT and on average 11.6 CBCT scans were included in our study. For each patient, all CBCT scans were matched to the planning CT on bony anatomy. Bladder contours were manually delineated for each planning CT (for model building) and CBCT (for model building and validation). The automatic segmentation method consisted of two steps. A patient-specific bladder deformation model was built from the training data set of each patient (the planning CT and the first five CBCT scans). Then, the model was applied to automatically segment bladders in the validation data of the same patient (the remaining CBCT scans). Principal component analysis (PCA) was applied to the training data to model patient-specific bladder deformation patterns. The number of PCA modes for each patient was chosen such that the bladder shapes in the training set could be represented by such number of PCA modes with less than 0.1 cm mean residual error. The automatic segmentation started from the bladder shape of a reference CBCT, which was adjusted by changing the weight of each PCA mode. As a result, the segmentation contour was deformed consistently with the training set to fit the bladder in the validation image. A cost function was defined by the absolute difference between the directional gradient field of reference CBCT sampled on the corresponding bladder contour and the directional gradient field of validation CBCT sampled on the segmentation contour candidate. The cost function measured the goodness of fit of the segmentation on the validation image and was minimized using a simplex optimizer. For each validation CBCT image, the segmentations were done five times using a different reference CBCT. The one with the lowest cost function was selected as the final bladder segmentation. Volume- and distance-based metrics and the accuracy of plan selection were evaluated to quantify the performance. Two to four PCA modes were needed to represent the bladder shape variation with less than 0.1 cm average residual error for the training data of each patient. The automatically segmented bladders had a 78.5% mean conformity index with the manual delineations. The mean SD of the local residual error over all patients was 0.24 cm. The agreement of plan selection between automatic and manual bladder segmentations was 77.5%. PCA is an efficient method to describe patient-specific bladder deformation. The statistical-shape-based segmentation approach is robust to handle the relatively poor CBCT image quality and allows for fast and reliable automatic segmentation of the bladder on CBCT for selecting the appropriate plan from a library of plans.

A voxel-based finite element model for the prediction of bladder deformation

A finite element (FE) bladder model was previously developed to predict bladder deformation caused by bladder filling change. However, two factors prevent a wide application of FE models: (1) the labor required to construct a FE model with high quality mesh and (2) long computation time needed to construct the FE model and solve the FE equations. In this work, we address these issues by constructing a low-resolution voxel-based FE bladder model directly from the binary segmentation images and compare the accuracy and computational efficiency of the voxel-based model used to simulate bladder deformation with those of a classical FE model with a tetrahedral mesh. For ten healthy volunteers, a series of MRI scans of the pelvic region was recorded at regular intervals of 10 min over 1 h. For this series of scans, the bladder volume gradually increased while rectal volume remained constant. All pelvic structures were defined from a reference image for each volunteer, including bladder wall, small bowel, prostate (male), uterus (female), rectum, pelvic bone, spine, and the rest of the body. Four separate FE models were constructed from these structures: one with a tetrahedral mesh (used in previous study), one with a uniform hexahedral mesh, one with a nonuniform hexahedral mesh, and one with a low-resolution nonuniform hexahedral mesh. Appropriate material properties were assigned to all structures and uniform pressure was applied to the inner bladder wall to simulate bladder deformation from urine inflow. Performance of the hexahedral meshes was evaluated against the performance of the standard tetrahedral mesh by comparing the accuracy of bladder shape prediction and computational efficiency. FE model with a hexahedral mesh can be quickly and automatically constructed. No substantial differences were observed between the simulation results of the tetrahedral mesh and hexahedral meshes (<1% difference in mean dice similarity coefficient to manual contours and <0.02 cm difference in mean standard deviation of residual errors). The average equation solving time (without manual intervention) for the first two types of hexahedral meshes increased to 2.3 h and 2.6 h compared to the 1.1 h needed for the tetrahedral mesh, however, the low-resolution nonuniform hexahedral mesh dramatically decreased the equation solving time to 3 min without reducing accuracy. Voxel-based mesh generation allows fast, automatic, and robust creation of finite element bladder models directly from binary segmentation images without user intervention. Even the low-resolution voxel-based hexahedral mesh yields comparable accuracy in bladder shape prediction and more than 20 times faster in computational speed compared to the tetrahedral mesh. This approach makes it more feasible and accessible to apply FE method to model bladder deformation in adaptive radiotherapy.