Bladder Filling Research Articles

Determination of the Effect of Patient-Specific Bladder Filling Protocol for Operated Prostate Cancer Patients on Bladder Volume and Doses Using Cone Beam Computed Tomography Dose Calculations

One of the problems in prostate cancer radiotherapy is the effect of bladder volume changes on irradiated target volume and bladder itself. The aim of this study is to develop a patient-specific bladder filling protocol (PSP) by the help of a bladder scanner (BS) in operated patients and to compare the volumetric and dosimetric parameters with that of the standard filling protocol (SP). For the PSP the patient was asked to empty his bladder and drink 500 mL of water. The changes in bladder volume was measured with BS every 5 minutes. The time to reach a 150-200 cc-volume was recorded. That specific time was used for CT simulation and treatment. For the SP after emptying the bladder and drinking 500 mL of water the patient was asked for urgency. Ten patients in each protocol received 72 Gy postprostatectomy salvage RT with VMAT technique. Catphan phantom was loaded into the Monaco 3.30 planning system after creating a CT-to-ED calibration graph with the aid of cone-beam computed tomography (CBCT) images. CBCT images were taken at five different fractions. OAR,CTV and PTV’s were contoured on CBCT images. Treatment plans done with the planning computed tomography (PCT) images were transferred to CBCTs without any mechanical or dosimetric changes. With the help of CBCT doses average treatment DVHs of each patient were obtained. PCT and BS correlation, changes in bladder volume and doses, standard deviations (SD), and their maximum and minimum values for PCT and CBCT were calculated for both protocols. Pearson correlation coefficient for PCT-BS was 0.74.For PSP average bladder volume and SDs, average bladder doses and SDs for PCT and CBCT were 136.92±25.4 cc and 130.38±25.1 cc, and 159.69±6.5 cGy and 160.79±10.1 cGy respectively. For SP the same values were 205.76±87.5 cc and 170.58±55.2 cc, 151.36±25.1 cGy and 163.54±18.3 cGy respectively. Average absolute difference of bladder volumes between PCT and CBCT were 48.47% for SP and 9.91% for PSP (p=0.007). Average absolute difference of bladder doses between PCT and CBCT for SP and PSP were 12.97% and 4.27% respectively (p=0.130). The dose difference between PCT and CBCT was not statistically significant for PSP (p=0.799). There was a trend for significance for SP (p=0.074). No statistically significant difference was found for bladder volumes between PCT and CBCT in both protocols (p=0.139 and p=0.139). With the PSP optimal bladder filling was obtained and maintained throughout the whole treatment course and it was reproducible in every fraction. Average CBCT doses were close to PCT doses, absolute difference of the bladder volumes and doses between PCT and CBCT, interfractional volume and dose changes were very small compared to SP. The findings of this study were reflected to our clinical practice and the determination of the changes in bladder volume and the time for obtaining optimal bladder volume by BS before and throughout the treatment in prostate cancer patients has become our routine clinical practice.

Attitudes and Opinions of Adolescent Females Regarding 2 Methods of Bladder Filling for Transabdominal Ultrasound: A Q-Sort Study.

Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study. Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study. In part 1, subjects underwent a semistructured interview to elicit their opinions regarding 2 methods of bladder filling: intravenous fluid or transurethral catheter. The summation of subject statements was then narrowed down to a final Q set of 25 statements. In part 2, a second sample of subjects independently arranged this Q set according to their own agreement or disagreement with each statement. Principal components analysis was conducted to examine factors or collections of statements representing a shared viewpoint and to describe commonalities. Part 1 was completed with 9 subjects, and part 2 with 26 subjects. Factors revealed from the Q-sort data included acceptance of tests deemed medically necessary, desire for parental involvement, and a wish to minimize discomfort. Most adolescents aligned with 1 of these 3 factors. Adolescent female patients varied in their attitudes and opinions regarding intravenous catheter hydration and Foley catheter placement for transabdominal ultrasound. Knowledge of adolescent viewpoints may help better inform practitioner-patient communication for this procedure.

Restoring the sense of bladder fullness for spinal cord injury patients

Abstract Spinal cord injuries (SCI) have vast effects on day-to-day life, including the loss of sensation and control of the bladder. Since elevated bladder pressures from urine production and storage can be detrimental to renal functionality, urologists recommend performing clean-intermittent catheterization (CIC) every two to four hours throughout the day. However, limitations in mobility make the high frequency of these trips to the bathroom prohibitive. Sometimes a patient׳s bladder fills to capacity before performing CIC and eventually leaks urine, causing unnecessary embarrassment. As such, continence is the primary concern of most SCI patients. The issue in performing CIC is that it is a time-based approach, whereas urine production does not occur at a constant rate. A demand-based ’bladder almost-full’ warning system would provide more useful notifications and help SCI patients plan their bathroom trips accordingly. In this work, we explore using near-infrared light to create a discrete, wearable, non-invasive bladder state estimation system using machine learning to determine urine volume in the bladder to provide continuous monitoring for a patient throughout the day. We do this through proof-of-concept evaluation studies using Monte Carlo simulations and describe our bladder state estimation system. We also highlight some preliminary results using the system and distinguish differences in light intensity between a full and empty bladder on a volunteer.

A Feasibility Study on the Role of Ultrasound Imaging of Bladder Volume as a Method to Improve Concordance of Bladder Filling Status on Treatment with Simulation

PurposeAccurate positioning of the prostate is of paramount importance to ensure optimal target coverage and normal tissue sparing in stereotactic ablative body radiation when large doses per fraction are delivered with tight margins around the prostate. Bladder and rectal filling play an important part in controlling the accuracy of a patient's setup and therefore the overall toxicities and outcomes. The aim of this study was to establish the value of characterizing patients' bladder filling kinetics at the time of simulation with ultrasound scans so that a predictive model can be used to ensure that a bladder volume at treatment would match at simulation. MethodsA prospective trial was conducted in unfavorable risk prostate cancer patients to evaluate the utility of ultrasound bladder monitoring. Thirty patients (n = 30) were enrolled in this study. Patients were required to void before simulation and then were given 500 mL of fluids to drink. Ultrasound measurements of the bladder were documented at 15-minute intervals for up to four measurements before simulation. On treatment, bladder volumes were measured at a single time point; typically, half an hour after the patient voided and consumed 500 mL of fluids. The kinetic model was then used to predict the optimal time to set up the patient for treatment such that the bladder volume at treatment would match the volume at simulation. Every patient had a cone beam computed tomography scan before each fraction to ensure accurate patient positioning before dose delivery. Bladder volumes at treatment were measured and compared with those at simulation on the cone beam computed tomography data sets using MIMVISTA software. ResultsOf 30 patients, 26 were analyzed. The comparison of the bladder contours at treatment compared to simulation yielded a DICE coefficient (similarity) of 0.76 ± 0.11. The largest variation in bladder size was seen in the anterior-posterior direction. ConclusionsThis study demonstrated that ultrasound monitoring of the bladder status was a valuable tool in ensuring reproducible bladder filling on treatment. The bladder kinetic model indicated the general time required to achieve optimal bladder filling was 60 minutes after voiding and drinking 500 mL of water.

Laboratory practical to study the differential innervation pathways of urinary tract smooth muscle.

In the mammalian lower urinary tract, there is a reciprocal relationship between the contractile state of the bladder and urethra. As the bladder fills with urine, it remains relaxed to accommodate increases in volume, while the urethra remains contracted to prevent leakage of urine from the bladder to the exterior. Disruptions to the normal contractile state of the bladder and urethra can lead to abnormal micturition patterns and urinary incontinence. While both the bladder and urethra are smooth-muscle organs, they are differentially contracted by input from cholinergic and sympathetic nerves, respectively. The laboratory practical described here provides an experiential approach to understanding the anatomy of the lower urinary tract. Several key factors in urinary tract physiology are outlined, e.g., the bladder is contracted by activation of the parasympathetic pathway via cholinergic stimulation on muscarinic receptors, whereas the urethra is contracted by activation of the sympathetic pathway via adrenergic stimulation on α1-adrenoceptors. This is achieved by measuring the force generated by bladder and urethra smooth muscle to demonstrate that acetylcholine contracts the smooth muscle of the bladder, whereas adrenergic agonists contract the urethral smooth muscle. An inhibition of these effects is also demonstrated by application of the muscarinic receptor antagonist atropine and the α1-adrenergic receptor blocker phentolamine. A list of suggested techniques and exam questions to evaluate student understanding on this topic is also provided.

Bladder Filling for PACE SABR Prostate Patients Receiving Radiotherapy: What is the Optimum Bladder Preparation Protocol? An Audit of Two Bladder Filling Regimes

Participants: 28 consecutive participants enrolled on the PACE trial, randomised to conventional or hypofractionated (SABR) radiotherapy (Table 1, Table 2, Table 3, Table 4).

Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study.

Introduction The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. Material and Methods Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. Results A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). Conclusions Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

Multicomponent Assessment of the Geometrical Uncertainty and Consequent Margins in Prostate Cancer Radiotherapy Treatment Using Fiducial Markers

The aim is to compute all sources of geometrical uncertainty in prostate radiotherapy using fiducial markers and determine the safety treatment margins. Based on the markers position, correlations between prostate rotation/deformation and rectal and bladder fillings as well as changes in prostate volume during the treatment course are analyzed. The study includes 375 pre-treatment CBCT images from 15 prostate cancer patients treated with hypofractionated radiotherapy. The position coordinates of the markers were obtained from each image acquisition. In addition, rectum and bladder were outlined on CBCTs. The intrafractional error was estimated by an additional post-treatment CBCT acquired on alternate days. Tau-Kendall analysis was performed to correlate organ fillings with prostate rotation/deformation. Delineation uncertainty was assessed from contours of 10 patients performed by two radiation oncologists and repeated twice. The CT contouring was assisted by a multiparametric MR approach combining a T2-weighted with diffusion-weighted imaging, and a gradient recalled echo for fiducial marker identification. Uncertainty associated to treatment unit was estimated from phantom measurements. The obtained clinical margins were 4.4, 7.3, 5.1 mm in the Left-Right, Superior-Inferior, and Anterior-Posterior directions, respectively, being the contouring the most important contribution. The mechanical limitations of the beam delivery system and the associated imaging device entailed errors of the same order as prostate motion, rotation or deformation. Weak correlations between variation of the rectal volume and the presence of rotations/deformations were found (correlation coefficient 0.182, p = 0.001 for rotations around lateral axis; correlation coefficients 0.1, p < 0.05 for deformations). The distance between markers decreased with session number, becoming more pronounced from fraction 13 and reaching 1 - 1.8 mm at the end of the treatment. In summary we have determined the optimal treatment margins based on geometrical uncertainty assessment using van Herk formalism. An appropriate preparation of rectum and bladder involves minimizing the effect of prostate rotations/deformations. The prostate tends to decrease in size during the treatment which could influence treatment re-planning strategies.

Gripping characteristics of an electromagnetically activated magnetorheological fluid-based gripper

The design and test of a magnetorheological fluid (MRF)-based universal gripper (MR gripper) are presented in this study. The MR gripper was developed to have a simple design, but with the ability to produce reliable gripping and handling of a wide range of simple objects. The MR gripper design consists of a bladder mounted atop an electromagnet, where the bladder is filled with an MRF, which was formulated to have long-term stable sedimentation stability, that was synthesized using a high viscosity linear polysiloxane (HVLP) carrier fluid with a carbonyl iron particle (CIP) volume fraction of 35%. Two bladders were fabricated: a magnetizable bladder using a magnetorheological elastomer (MRE), and a passive (non-magnetizable) silicone rubber bladder. The holding force and applied (initial compression) force of the MR gripper for a bladder fill volume of 75% were experimentally measured, for both magnetizable and passive bladders, using a servohydraulic material testing machine for a range of objects. The gripping performance of the MR gripper using an MRE bladder was compared to that of the MR gripper using a passive bladder.

Dynamics of Vaginal Cuff Displacement Due to Bladder Filling in Adjuvant Pelvic Irradiation for Uterine Cancers

RTOG Consensus contouring guidelines for IMRT recommend combining two separate clinical target volumes (CTV) for vaginal cuff based on full and empty bladders to create an ITV (Internal Target Volume). In this study, we report the magnitude of vaginal cuff position displacement when going from an empty to full bladder in post-operative patients with uterine cancers. We examined 42 patients treated with pelvic irradiation at our institution for post-operative uterine cancers FIGO stage I - IIIC. The median age was 67 years (range 41 to 81). Patients were simulated in the supine position using appropriate immobilization. A urinary catheter was inserted, and the bladder was drained to obtain the initial empty bladder (EB) scan. After this, the bladder was filled with diluted contrast (200-300 cm3), and a second full bladder (FB) CT scan was obtained. The amount of bladder fill was determined depending on the volume tolerable by the individual patient. Average Rectal distension in the AP direction was 28.9 ±7.5 mm. The vaginal cuff was visualized on the CT scans by injecting a mixture of contrast and lubricant. The EB and FB CT scans were co-registered before contouring. Target volumes and normal structures were contoured according to RTOG contouring atlas. For each patient, the vaginal cuff wall position displacement in all directions for FB in reference to EB was measured. Additionally, the vaginal cuff width and thickness at a reference level (1 cm inferior to the apex) for EB and FB were also measured. In representative patients, weekly CBCT images were obtained to assess bladder volume at treatment. The average bladder volume from FB CT scans was 272.9 cm3(range 197.5 to 485.7). The average and maximum values for vaginal cuff wall displacement due to FB relative to its position on the EB scan are summarized in Table 1. The vaginal cuff displacement appears to be more favored in the cranial direction. At the reference level, the vaginal cuff width and thickness values were 59.6 ± 12 mm, 16 ± 4.9 mm for EB and 65.8 ±12.8 mm, 12.6 ± 4.1 mm for FB, respectively. CBCT data revealed that the bladder volumes at treatment did not exceed FB nor were below EB values at simulation. Our study data quantify magnitude of vaginal cuff positional variation with bladder filling from EB to FB state. The use of a urinary catheter in all patients eliminated the need for repeat scans during CT/simulation to obtain true EB and FB scans. As also supported by our study limited CBCT data, the use of a urinary catheter to drain bladder as well as determine FB volume ensures that the intra-treatment bladder volumes never exceed nor fall below the FB and EB bladder volumes at simulation and thereby guarantees that the maximum vaginal cuff position variation has been accounted in the ITV generation.Abstract 2750; Table 1Vaginal Cuff Wall Displacement, mmRight WallLeft WallAnterior WallPosterior WallCranialCaudal(Mean ±SD)7.7 ±5.56.6 ±3.66.7 ±2.67.0 ±2.57.7 ±5.50.8 ±1.2Maximum20.314.718.514.522.52.5 Open table in a new tab

Intrafractional Motion of Target Volumes and Organs at Risk Due to Bladder Filling: Implications for MR-Only Prostate Radiation Therapy

As magnetic resonance simulation (MR-SIM) emerges as a primary treatment planning modality for prostate cancer, it becomes critical to quantify the uncertainties introduced in an MR-only workflow. Given the long image acquisition times encountered in MRI, we sought to characterize the temporal and spatial intra-fractional changes between the prostate, seminal vesicles (SVs), and other organs at risk in response to bladder filling conditions. Serial T2-weighted MR-SIM data (3-6 timepoints/subject at 1.0T, 1.5T, or 3.0T, 38 evaluable timepoints) were acquired in 10 immobilized subjects using a fixed bladder filling protocol (bladder void, 20 oz water consumed, 10 oz consumed mid-session). Delineations were performed by one physician including prostate, SVs, and organs at risk (bladder, rectum, penile bulb) to yield 370 evaluable contours. Bony rigid registration (3 degrees of freedom) was performed for serial T2 data to isolate local organ effects. To quantify the impact of systematic bladder filling, temporal assessments of the volumes, center of mass, and Dice similarity coefficients (DSCs) were performed. To assess serial target displacements, centroid differences between the prostate and proximal SVs were compared across timepoints. Subjects had an average bladder volume difference of 62 ± 15% between initial and final timepoints. When compared to the initial prostate volume, mean DSCs of the prostate went from 0.81 ± 0.07 at the middle timepoint to 0.75 ± 0.07 at the final. A large reduction in DSC was observed for the proximal SVs (0.44 ± 0.22 at the middle time point vs. 0.32 ± 0.17 for the final). Overall, the median vector displacement of the penile bulb was 2.2 mm. After excluding a subject with an extreme case of rectal gas, the average rectum volume difference from the initial timepoint was 5.9 ± 10.3%. The prostate showed <1 mm lateral displacement and > 3mm in centroid shift in 6/10 cases (4 posteriorly and 2 anteriorly due to changes in rectal status). The SVs shifted posteriorly with bladder filling (7/10 cases were > 3mm). The centroid differences between the prostate and proximal SVs were >2mm in 4/10, 6/10, and 7/10 of subjects in the left-right, anterior-posterior, and superior-inferior directions, respectively, suggesting that they move independently with bladder status. As bladder filling increased, DSC decreased for the prostate, SVs, and OARs. In addition, large, systematic shifts were observed in the prostate and SVs (particularly anterior/posterior), although these were subject dependent due to confounders such as rectal status. This suggests that care must be taken during patient preparation to minimize these effects. Future work will incorporate dosimetric consequences using MR-only treatment planning in response to non-uniform organ displacement.

Evaluation of High Doses to Small Volumes of the Bladder and Rectum During HDR Endocavitary Vaginal Brachytherapy With Bladder Filling Techniques

There are approximately 4800 cases of vaginal and 60,000 cases of endometrial cancer diagnosed each year in the United States. Treatment for these diseases often includes the use of HDR endocavitary vaginal brachytherapy for boosting the dose to the Vaginal apex. The intent of this work is to determine if bladder filling techniques influence the high dose to different volumes of the Bladder and Rectum. 10 sequential patients scheduled to receive HDR treatments for gynecologic cancer were selected for evaluation. A Foley catheter was placed into the bladder using sterile technique and then placed to straight drain.(“Empty bladder CT”) The patient was immobilized using standard techniques. A CT scan was performed of the patient from bottom of SI joints to the distal end of the vaginal cylinder with slice thickness of 1.25mm, to include the vagina, bladder and rectum to the level of recto-sigmoid junction. The CT scan was repeated after 120 cc’s of saline & contrast were instilled into the bladder with the Foley catheter clamped. (“Full bladder CT”). Both sets of CT data were exported to the treatment planning system. The Dosimetrist and Physician contoured the Rectum, Bladder, and Urethra on both image sets. The physician determined the treatment length and depth (standard 5mm) for the treatment delivery. Dose structures were constructed on both data sets and the dwell position and times were optimized. Comparison DVH’s and volume doses for the Rectum, Bladder, and Urethra were determined for each data set. The dose increased on average for all small volumes of the Bladder when the “full bladder” was used for treatment planning as compared to the “empty bladder” plans. This increase was on the order of 5% (±1.0%) for Bladder volumes of (0.03cc, 1cc’s, 2cc’s, 3cc’s, 10cc’s, and 20cc’s.). For the Rectum, the dose was increased by 1.5%, but the variability was higher on the order of (±1.2%) for Rectum volumes of (0.03cc, 1cc’s, 2cc’s, 3cc’s, 10cc’s, and 20cc’s). In contrast, the mean dose for the Bladder and Rectum decreased by 20%, and 2% respectively with the "full bladder”. With the “empty bladder” the dose to 1cc, and 2cc of the Urethra was reduced on average by 3%. Bladder filling for this cohort of patients increased the average high dose to small volumes of the Bladder and Rectum. The increase in dose to the Bladder was approximately 5% and was more consistent for all patients when compared to the average dose increase of 1.5% for the Rectum.

Dosimetric Effects of Bladder Filling Volume on Small Bowel in Intensity-Modulated Radiation Therapy Treatment Planning of External Beam Radiation Therapy for Cervical Cancer

Dosimetric Effects of Bladder Filling Volume on Small Bowel in Intensity-Modulated Radiation Therapy Treatment Planning of External Beam Radiation Therapy for Cervical Cancer

Is Detrusor Contraction during Rapid Bladder Filling Caused by Cold or Warm Water? A Randomized, Controlled, Double-Blind Trial.

We investigated whether detrusor contraction during rapid bladder filling is provoked by cold or warm water. Patients with neurogenic lower urinary tract dysfunction were included in this randomized, controlled, double-blind trial. At the end of a standard urodynamic investigation patients underwent 2 bladder fillings using a 4C ice water test or a 36C warm water test saline solution at a filling speed of 100 ml per minute. The order was randomly selected, and patients and investigators were blinded to the order. The primary outcome measure was detrusor overactivity, maximum detrusor pressure and maximum bladder filling volume during the ice and warm water tests. Nine women and 31 men were the subject of data analysis. Neurogenic lower urinary tract dysfunction was caused by spinal cord injury in 33 patients and by another neurological disorder in 7. Irrespective of test order detrusor overactivity occurred significantly more often during the ice water test than during the warm water test (30 of 40 patients or 75% vs 25 of 40 or 63%, p = 0.02). When comparing the ice water test to the warm water test, maximum detrusor pressure was significantly higher and maximum bladder filling volume was significantly lower during the ice water test (each p <0.001). The order of performing the tests (ice water first vs warm water first) had no effect on the parameters. Our findings imply that the more frequent detrusor overactivity, higher maximum detrusor pressure and lower bladder filling volume during the ice water test compared to the warm water test were caused by cold water. This underlies the theory of a C-fiber mediated bladder cooling reflex in humans.

Re: Brain Activity on fMRI Associated with Urinary Bladder Filling in Patients with a Complete Spinal Cord Injury.

Re: Brain Activity on fMRI Associated with Urinary Bladder Filling in Patients with a Complete Spinal Cord Injury.

The Effect of Partial Bladder Filling on Post-Operative Time to Void in Minimally Invasive Gynecologic Procedures [13D

INTRODUCTION: In urogynecologic procedures, backfilling the bladder with 300 cc has been shown to be a better predictor of successful post-operative bladder emptying than completely emptying the bladder at the end of surgery (1). The participants of this study were those undergoing GYN continence procedures, meaning they had some baseline urinary dysfunction. Our study attempts to see the effect on time to void in patients undergoing minimally invasive GYN procedures (laparoscopic or robotic hysterectomy or myomectomy) without baseline urinary dysfunction. The experimental group will have the bladder partially filled at 150cc and the control group will have the bladder completely emptied at the end of the procedure. METHODS: This is a double-blind randomized controlled trial. Sample calculations based on total time required to void after Foley catheter removal assuming an alpha level of 0.05 and beta of 0.8 indicate that 36 patients are needed in each group to determine a difference of 20 minutes in voiding time. Up to 38 patients will be enrolled to take into account a 5% dropout rate. Recruitment started on March 20,2016 with 32 patients recruited thus far. RESULTS: Preliminary comparisons between time to void in PACU and total PACU stay time between partially filled and empty bladder are as follows: 78-minute decrease in time needed to void in the PACU and 74-minute decrease in PACU stay time, respectively. CONCLUSION: This trial has potential to prove our hypothesis that partial bladder back-filling decreases time to void after minimally invasive benign gynecologic procedures, decreasing PACU length of stay and cost.

EP-1845: The impact of intra-fractional bladder filling on adaptive bladder radiotherapy

A retrospective audit on the “Plan of the day” (POD) selection and intra-fractional bladder fillings were carried out on twenty adaptive bladder radiotherapy patients at a single institution. Treatment time, differences in bladder volume and displacement of outer bladder wall expansion over the treatment fraction were analysed. Average treatment time was 8.9 minutes. The mean percentage difference in bladder volume pre and post treatment was 13.7%, resulting in expansion of the bladder predominately in the superior and anterior directions. This audit confirmed that the institution’s POD process sufficed without being significantly affected by the intra-fractional bladder filings.

Bladder Fill after Laparoscopic Inguinal Hernia Repair Reduces Time to Discharge

Laparoscopic inguinal herniorrhaphy (LIH) has a relatively high risk of urinary retention. Bladder dysfunction may delay discharge after LIH. We hypothesized that filling the bladder before Foley catheter removal decreases time to discharge (TTD) after LIH. A secondary aim was to determine incidence of postoperative urinary retention (POUR) after bladder fill (BF). We reviewed a consecutive series of total extraperitoneal and transabdominal preperitoneal LIH procedures performed by a single surgeon at our institution from 2010 to 2013. All patients were catheterized during LIH, and selected patients received a 200-mL saline BF before Foley catheter removal. Patients were required to void >250 mL before discharge. TTD and incidence of POUR were compared between the BF and no-BF groups. A total of 161 LIH cases were reviewed. BF was performed in 89/161 (55%) of cases. TTD was significantly shorter in the BF versus the no-BF group (222 vs 286 minutes, respectively; P < 0.01). Patient and operative characteristics were similar between the BF and no-BF groups (P > 0.05). Incidence of POUR in the BF and the no-BF group was 10.1 and 16.7 per cent, respectively; however, this difference was not significant (P = 0.22). No postoperative urinary tract infection occurred in either group. In conclusions, postoperative BF significantly reduces TTD after LIH. Further studies may help to determine whether shorter postanesthesia care unit time and lower POUR rates associated with BF can lower LIH procedural costs and increase patient satisfaction.

MP85-06 BRAIN NETWORKS CONTROLLING BLADDER FILLING AND VOIDING

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2017MP85-06 BRAIN NETWORKS CONTROLLING BLADDER FILLING AND VOIDING Hanneke Verstegen, John Mathai, Mark Zeidel, and Joel Geerling Hanneke VerstegenHanneke Verstegen More articles by this author , John MathaiJohn Mathai More articles by this author , Mark ZeidelMark Zeidel More articles by this author , and Joel GeerlingJoel Geerling More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2668AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms (LUTS) are common and poorly understood; treatment is often ineffective. Failure of neural control of bladder function likely contributes to LUTS symptoms in many patients. Prior studies have shown that the pontine micturition center (PMC) directly controls voiding. Within the PMC corticotropin releasing hormone neurons (PMCCRH) project axons directly to spinal sacral cord nuclei that control bladder contraction. Here we show that PMCCRH neurons are critical for voiding, and identify neurons, particularly in the ventrolateral periaqueductal gray (PAGVL) which directly modulate PMCCRH and alter voiding. METHODS We inject adeno-associated viruses expressing proteins in a Cre-dependent fashion into anatomically defined regions of mice expressing Cre recombinase in specific neural types, to cause highly selective expression of these probes in target neuron populations. We monitor conscious voiding with micturition video thermography (MVT), and CMG under anesthesia while monitoring/stimulating specific neuron groups. RESULTS Stimulating PMCCRH neurons using designer receptors exclusively activated by designer drugs (DREADDs) produces urinary frequency in awake mice and on anesthetized CMG. Also, ablating PMCCRH neurons by selective expression of diphtheria toxin A disrupts normal voiding and the normal CMG voiding reflex. To identify neurons which provide input to PMCCRH, we used modified rabies virus and cholera toxin B labeling of PMCCRH and confirmed our results with viral anterograde tracing. Afferents to PMCCRH are located in PAGVL, the preoptic area, the lateral hypothalamic area, and other sites. Because sacral afferents sensing bladder filling project to PAGVL we determined the impact of stimulating Glutamatergic or GABA-ergic neurons (PAGVLGLUT or PAGVLGABA) in this region. Chemogenetic or optogenetic stimulation of PAGVLGLUT neurons leads to voiding and detrusor contraction. By contrast, chemogenetic or optogenetic activation of PAGVLGABAinhibits voiding and delays detrusor contraction on CMG. CONCLUSIONS 1. PMCCRH are driver neurons for detrusor contraction/voiding. 2. PAGVLGLUT project to PMCCRH, and when fired drive voiding/detrusor contraction. 3. PAGVLGABA project to PMCCRH and inhibit voiding/detrusor contraction. PAGVL, which receives bladder-based sacral afferents, likely controls bladder filling, and is a potential target in efforts to control urge incontinence and urgency symptoms of LUTS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1150 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hanneke Verstegen More articles by this author John Mathai More articles by this author Mark Zeidel More articles by this author Joel Geerling More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Effect of Partial Bladder Filling on Post-Operative Time to Void in Minimally Invasive Gynecologic Procedures

The Effect of Partial Bladder Filling on Post-Operative Time to Void in Minimally Invasive Gynecologic Procedures