Empty Bladder Research Articles

Effects of Visceral Interoception on Topological Properties of the Brain - A Graph Theory Analysis of Resting state fMRI.

Recent neuroimaging studies have employed graph theory as a data-driven approach to describe topological organization of the brain under different neurological disorders or task conditions and across life span. In this exploratory study, we tested whether subtle differences in interoception related to intravesical fullness can alter brain topological architecture in healthy participants. 17 right-handed women underwent a series of resting state fMRI scans that included catheterization and partial bladder filling. Using a whole brain regions of interest (ROIs), we computed several graph theory metrics to assess the efficiency of brain-wide information exchange. Results showed that brain network's topological properties significantly changed in many brain regions when we binary compared different interoceptive resting state conditions. Notably, we observed changes in global efficiency in the salience network, the central executive network, anterior dorsal attention network and the posterior default-mode network (DMN) as bladder became full and interoceptive signals intensified. Moreover, degree (the number of connections for each node), and betweenness centrality (how connected a particular region is to other regions) differed between the empty bladder, the catheterized empty bladder, and the catheterized and partially filled bladder. Comparing resting state data before and after an interoceptive task (repeated intravesical infusion and drainage) further showed increased average path length for the salience networks and decreased clustering coefficient of the DMN. These results suggest visceral interoception influences brain topological properties of resting state networks.

Brain functional network alterations caused by a strong desire to void in healthy adults: a graph theory analysis study.

This resting-state functional magnetic resonance imaging (fMRI) study determined the functional connectivity (FC) changes and topologic property alterations of the brain functional network provoked by a strong desire to void in healthy adults using a graph theory analysis (GTA). Thirty-four healthy, right-handed subjects filled their bladders by drinking water. The subjects were scanned under an empty bladder and a strong desire to void states. The Pearson's correlation coefficients were calculated among 90 brain regions in the automated anatomical labeling (AAL) atlas to construct the brain functional network. A paired t test (P < .05, after false discovery rate [FDR] correction) was used to detect significant differences in the FC, topologic properties (small-world parameters [gamma, sigma], Cp, Lp, Eglob, Eloc, and Enodal) between the two states in all subjects. Both the two states showed small-world network properties. The clustering coefficient (Cp) and local efficiency (Eloc) in the whole brain network decreased, while the FC within the default mode network (DMN) increased during the strong desire to void compared with the empty bladder state. Moreover, an increased nodal efficiency (Enodal) was detected in the basal ganglia (BG), DMN, sensorimotor-related network (SMN), and visual network (VN). We detected FC changes and topologic property alterations in brain functional networks caused by a strong desire to void in healthy and suggest that the micturition control may be a process dominated by DMN and coordinated by multiple sub-networks (such as, BG, SMN, and VN), which could serve as a baseline for understanding the pathologic process underlying bladder dysfunction and be useful to improve targeted therapy in the future.

The effect on conception rates of bladder fullness during intrauterine insemination: A retrospective cohort study

Aim: Embryo transfer in in-vitro fertilization (IVF) cycles is performed with a full bladder, being careful to avoid surgical instrumentation to the cervix as much as possible, so that uterine contractions are not stimulated. The aim of this study was to investigate whether a full bladder during the application of intrauterine insemination increased pregnancy rates by correcting the cervico-uterine axis, thereby enabling easier access of sperm to the uterine cavity.Methods: This study included 61 patients undergoing IUI procedures, which were performed on patients with infertility since at least one year and those with at least one open oviduct as seen on hysterosalpingography (HSG). Patients’ demographic data, folliculometry measurements, spermiogram parameters, bladder fullness status on abdominal ultrasonography during the application, and beta hGC levels on the 14th day following the application were recorded from the patient files. Results: No statistically significant differences were determined between the two groups in terms of demographic data and folliculometry measurements. The conception rate was 20% in the full bladder group, and 12% in the empty bladder group. Tenaculum application was at a statistically significantly higher rate in the empty bladder group than in the full bladder group (P&lt;0.001). The conception rate was insignificantly higher in the full bladder group (P=0.342).Conclusion: A full bladder facilitates sperm access to the uterine cavity and may increase conception rates. There is a need for further prospective randomized studies with a larger series to obtain better results.

MP07-13 REFRACTORY BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS

INTRODUCTION AND OBJECTIVE: Bladder pain syndrome/Interstitial cystitis (BPS/IC) as a pro-inflammatory chronic bladder state leads to functional changes in bladder afferent pathways like pain amplification, increased activity and recruitment of silent nociceptive neurons and sensitization of specific brain areas. Default Mode Network (DMN) is a set of regions activated during resting state, usually barred during specific tasks, reflecting the intrinsic activity of the brain. On the other hand, the sensorimotor network (SMN) plays a key role in structural neuroplasticity, usually present in chronic pain conditions. Our aim was to assess brain DMN and SMN in BPS/IC patients with and without noxious bladder stimuli using functional brain MRI (fMRI). METHODS: Six BPS/IC female patients, previously evaluated with a physical examination, bladder diary and bladder-pain related scores underwent 3 Tesla fMRI brain scanner. Acquisitions consisted of 10-minute blood oxygen level-dependent echo-planar imaging at rest. The first acquisition with an empty bladder state and a second one with suprapubic pain and/or bladder maximum capacity, after instillation of saline solution at room temperature, were performed. Data was processed based on the method of the independent component analysis using the MELODIC tool from Functional magnetic resonance imaging of the Brain Software Library (FSL). A semi-quantitative analysis was performed afterward. RESULTS: Patients mean age was 42.6 years (±5); mean VAS was 7±0.7; mean OSS was 24.8±1.9 mean day frequency and night frequency were 9.2±2.2 and 2.8±1.0 respectively; mean bladder maximum capacity was 260±54 ml and mean value for QoL (0-6) was 5±1. Four patients had Hunner’s lesions. All patients showed a comparable DMN activation in both empty and full bladder states and all of them presented a higher sensorimotor network (SMN) activation at an empty bladder state. There was no correlation between the presence of Hunners’ lesions and the pattern of network activity. CONCLUSIONS: Overlapping DMN activation at both empty and full bladder state, and consistently SMN deactivation with pain supports the relevant role of these networks in BPS/IC, as previously reported in other chronic pain syndromes.Source of Funding: None.

Retrograde CT urethrography using a power injector quantitatively reveals effects of bladder distension on urethral size in healthy male Beagle dogs.

Quantitative analysis of the normal retrograde urethrogram is well reported in radiography, but studies on CT urethrography are lacking. Recently, a method of retrograde CT urethrography using a power injector was described. The purpose of the current, prospective, analytical study was to quantify the urethral size of five, healthy, intact, male Beagle dogs using retrograde CT urethrography and a power injector. With the injection rate of the power injector set at 0.3mL/s, 1mL/kg of diluted contrast medium (15mg I/mL) was injected, and a CT examination was performed. The state of the initial urethrogram taken was defined as "empty bladder." The same procedures were repeated with the injection of an additional 1mL/kg of diluted contrast medium until the ureteral reflux was seen (distended bladder). There was a significant difference in volumes between the empty and distended bladder, but the membranous urethra showed the least difference (P=.0044) among the three regions (P<.0001 for the prostatic and penile urethra). Urethral diameters at six sites were measured from sagittal images, and the sites of measurements were adopted from the earlier radiographic studies. The most significant difference in the urethral diameters between the empty and distended bladder occurred at the cranial and middle prostatic urethra (P<.0001). The results of this study can be useful for interpreting the results of retrograde CT urethrography. Care must be taken when narrowing is suspected at the prostatic urethra, and if necessary, further distension of the urinary bladder should be tried.

Effect of third trimester formation of lower uterine segment on the thickness of previous cesarean scar measured by transvaginal sonography

BackgroundSeveral studies have been conducted using various methods to evaluate the correlation of lower uterine segment (LUS) measurement with the risk of uterine rupture or dehiscence, with relative success.Patients and methodsA cross-sectional study was conducted on 200 patients admitted for cesarean section. The patients were subjected to complete general, obstetric examination, and ultrasound measurement of LUS scar by transabdominal ultrasound (TAS) on partially full bladder and by transvaginal ultrasound (TVS) on empty bladder, and measurement of actual thickness intraoperatively.ResultsUterine dehiscence was found in 24 (12%) cases. At 28 weeks, the mean scar thickness as measured by TAS was 6.796±1.84 mm, with a range of 3.6–11 mm, and by TVS was 4.11±1.29 mm, with a range of 3–10.1 mm, and at 38 weeks, the mean scar thickness as measured by TAS was 6.796±1.84 mm, with a range of 3.6–11 mm, and by TVS it was 2.9±0.9 mm, with a range of 1.3–3.9 mm. However, intraoperatively, it was 4.12±1.25 mm, with a range of 3–9 mm, by TVS. The cutoff value was 2.33 mm, and this yields a sensitivity of 96.2% and a specificity of 90%.ConclusionThe LUS scar thickness measured sonographically is a good predictor of uterine scar dehiscence in pregnant women at term with previous cesarean section. Data from the present study demonstrated the superiority of TVS over TAS for the assessment of LUS scar thickness.

Ultrasound derived-parameters and symptom severity scores as noninvasive predictors of bladder outlet obstruction in patients with benign prostatic enlargement

Introduction: Benign prostatic hyperplasia (BPH) is common in men over 50 years and causes lower urinary tract (LUT) symptoms. There is an emerging need to explore the value of utilizing ultrasound (US)-derived parameters of the LUT as noninvasive predictors of the degree of bladder outlet obstruction (BOO) from BPH and determine if they correlate with the symptom severity observed in these patients. This study aimed to determine the utility of US-derived parameters of the LUT (prostate volume [PV], bladder wall thickness [BWT], and postvoid residual volume [PVR]) in predicting severity of BOO and correlating them with the symptom severity scores – International Prostate Symptom Score (IPSS) and quality of life (QoL) – in patients with BPH in our practice. Methodology: We prospectively studied 100 newly diagnosed patients with symptomatic BPH who presented to the urology outpatient clinic and were referred to the radiology department for transabdominal scan of the urinary bladder and prostate. The patients' age, IPSS, and QoL and their BWT1 (full bladder), BWT2 (empty bladder), PV, and PVR were measured using transabdominal US scan. Correlation was done using Pearson's correlation coefficient, and P Results: The mean age of the participants was 60 years. The mean BTW1 and BTW2 were 4.66 mm and 25.80 mm, respectively. The mean IPSS was 16, with a majority (42%) having severe symptoms. There is a negative insignificant correlation between PVR and BTW2 (r = −0.053, P = 0.603). There is a weak but statistically insignificant correlation between QoL and BWT. There is a weak but insignificant correlation between PV and IPSS (r = 0.193, P = 0.055). There is a weak but insignificant correlation between IPSS and BWT. There is a moderate and statistically significant correlation between IPSS and PVR (r = 0.350, P Conclusion: In our patients, we found that BWT had an insignificant correlation with QoL and a negative correlation with PVR, respectively. We could show, however, that in them, PVR and IPSS were significantly correlated.

Neuromodulation for Restoration of Urinary and Bowel Control.

Control of the lower urinary tract is a complex, multilevel process that involves the peripheral and central nervous systems. Patients with spinal cord diseases or injuries present with multiple bladder and bowel problems. The commonest are urinary, urgency, frequency, urge incontinence, retention and/or fecal incontinence. Though the first reports of neurostimulation to empty bladder came in 1970s', it was only in 1988 that Schmidt and Tanagho restarted discussion and application of neuromodulation and electrical stimulation of sacral nerve in urology. In April, 1999 - FDA approved the InterStim System for treatment of symptoms of urgency-frequency and urinary retention. In October 2000, Medtronic Commercial Release for SNS-Bowel was approved. In October 2002, the Tined lead was launched and N'Vision programmer was launched in the official market in Europe. SNM is now considered the third line of management in refractory cases of OAB, chronic NOUR, frequency and urgency. Role in neuropathic bladder is still being assessed. SNM includes a thorough preoperative assessment, PNE (Percutaneous Nerve Evaluation) without any muscle relaxation and finally installation of a permanent IPG after assessing reponse. We have an experience of over 20 patients in last 11 years. These include patients of refractory OAB, chronic NOUR and Cauda Equina Syndrome. We do a two-staged procedure in view of the high cost and abide by the AUA, EAU and ICS guidelines. Our long term results for neuropathic OAB are awaited.

Intensity-Modulated Radiotherapy is Superior to Three-Dimensional Conformal Radiotherapy in the Trimodality Management of Muscle-Invasive Bladder Cancer with Daily Cone Beam Computed Tomography Optimization.

Intensity modulated radiation therapy (IMRT) using a volumetric-modulated arc therapy technique may offer dosimetric and clinical benefits compared to the historical standard of care 3D-conformal radiotherapy (3D-CRT) in definitive treatment of bladder cancer. We hypothesized that IMRT with CBCT would reduce dose to the rectum, bowel, and bladder compared to 3D-CRT. We reviewed nineteen patients treated with maximal transurethral resection of bladder tumor followed by concurrent chemotherapy with IMRT. All patients received 45 Gy to the entire empty bladder followed by 19.8 Gy tumor boost treated with full bladder. 3D-CRT treatment plans were created for the same prescription. Paired t-test or Wilcoxon matched-pairs signed rank test analyzed dosimetry and bladder volumes. The rectum and bowel V40, V45, V50, V55, and V60 were reduced by over 50% in the IMRT plans compared to 3D-CRT (p<0.0001). IMRT also reduced volume of bladder irradiated compared to 3D-CRT (p<0.01). After CBCT, patients were likely to undergo clinically significant shifts ≥ 0.5 cm before boost delivery (p=0.001). Bladder volumes were significantly lower during boost treatments compared to pre-treatment simulation (p=0.002). There were 4 (21%) grade 3 genitourinary toxicities and 1 (5%) grade 3 gastrointestinal toxicity. IMRT is superior to 3D-CRT for bladder cancer and spares dose to bowel, rectum, and bladder with improved acute toxicity compared to published clinical literature. For boost treatment, daily full bladder volume and positioning are not always reproducible, supporting the need for CBCT for optimal localization of the primary bladder tumor.

Is the strong desire to void a source of diverted attention in healthy adult volunteers?

The strong desire to void (SDV) induces changes in both cognition and gait. This may be due to the sensation of urinary urge acting as a source of diverted attention. This exploratory study examined the influence of SDV and a standardized distracting task on the performance of two measures of cognition, a simple reaction time (SRT) test and the trail making B test (TMT-B). 18 volunteers, 8 male and 10 female, without lower urinary tract symptoms (LUTS) (mean age: 20.5, range: 20-47), performed a test of SRT and the TMT-B under three conditions; undistracted with an empty bladder, while experiencing SDV, and when performing a simultaneous distracting task, the auditory n back test. A statistically significant increase in SRT was found when experiencing SDV and when distracted compared with the undistracted, bladder empty condition. The time taken to compete the TMT-B significantly increased with distraction but was not affected by SDV. SDV induced a similar but smaller change in reaction time when compared with a distracting task, suggesting that SDV may act as a source of diverted attention in continent, healthy volunteers.

Thermometric panel of the anterior abdominal wall and prognostic axillary-abdominal coefficient

Complications of acute appendicitis in children, infiltrates, abscesses and peritonitis remain relevant in pediatric surgery because they are difficult to diagnose and they have clinical features. Finally, they make up 75% of the patients in the surgical departments which carried out urgent surgical intervention. On appendicular peritonitis accounts for up to 28% of children with delays in seeking medical help.In addition, despite the latest technology, 20% of patients with acute appendicitis is not installed on time and, as a consequence, the development of complications. Appendicular infiltrate is diagnosed from 0.2% to 14.6% of cases. Periappendicular abscess record in patients from 1.5% to 12.6%. Purulent inflammation of the greater omentum in the form of destructive appendicitis was diagnosed in 30% of patients under the age of 7 years and 70% of patients older than 7 years.On postoperative infiltrates and abscesses of an abdominal cavity has from 1.1% to 10.5% of patients of the total number of limited forms of peritonitis and to 40.3% of the patients with General peritonitis, as a complication of postoperative infiltrative omantic occurs in patients from 0.02% to 4.52%.In the diagnosis of important localization, reasons for the development of infiltrates, abscesses of abdominal cavity in children.Described in the guidelines for surgery in the first half of the twentieth century "softening" tumoroids for today practically does not occur. Feeling dense sedentary infiltration even during the operation makes it impossible to judge about the organ and tissue structure and the presence of abecedarian. Traditional laboratory data are not specific for the diagnosis of intra-abdominal infiltrates and abscesses. They characterize the presence of the inflammatory process and to some extent the intensity of inflammation.In recent years, among medical imaging systems septic foci and control of the postoperative period, takes its place remote infrared thermometry.Despite the use of modern methods of diagnosis and treatment, there is a stable mortality rate from 0.2 to 0.4%, while appendicularia peritonitis, they account for between 0.7 and 23%.Thus, from the above information it follows that at the present stage in the early stages of the formation of infiltrates and abscesses of abdominal cavity in children reliable verification difficult.Materials and methods. The work is based on the analysis of the results of thermometry of the anterior abdominal wall of 33 patients with appendicular infiltrates and abscesses of the abdominal cavity, who used remote infrared thermometry. The comparison group included 70 children who were hospitalized in the surgical department with suspected acute appendicitis. The age of patients ranged from 5 to 17 years (10,21±0,37 years).When determining the temperature of the anterior abdominal wall, patients were in a horizontal position on the bed with an open abdominal wall. After adapting the skin to the microclimate for 10 minutes, at an ambient temperature of 19-22°C, on an empty stomach and with an empty bladder. According to the scientific literature, the temperature of the anterior abdominal wall, in the absence of an inflammatory focus, is 34.2-34.6°C.The local temperature of the anterior abdominal wall was measured at 26 points, located on a plane forming the panel of the anterior abdominal wall, at the intersection at right angles of 5 vertical and 6 horizontal lines, starting from the upper divisions from right to left.Results. Thermometry has been shown to indicate the variability of the temperature of the anterior abdominal wall in children - various indicators for both primary and secondary infiltrates, abscesses of the abdominal cavity.The average temperature of the anterior abdominal wall in children without surgical pathology, according to measurements at the points of the thermometric panel, was 34,25±0,05°C. The average axillary temperature was 36,65±0,01°C. The prognostic axillary-abdominal coefficient (PAAC) in this group of patients was at the level of 2,43±0,07°C.In patients with infiltrates and abscesses of the abdominal cavity, PAAС had a value of -1,16±0,06°С&lt;0°С – left shift, at the maximum point of hyperthermia (39,16±0,14°С) on the thermometric panel of the anterior abdominal wall. With primary abdominal infiltrates -0,82±0,08°С&lt;0°С and 38,9±0,47°С, PAA -1,25±0,05°С&lt;0°С and 39,28±0,14°C. In patients with a SAI development of -0,5°С&lt;0°С and 37,9°С (one observation), and in the conditions of the development of SAA -1,57±0,21°С&lt;0°С and 39,45±0,28°С. This indicator indicates the focus of inflammation and determines the boundaries of the spread of the inflammatory process in the abdominal cavity.Conclusions. In the postoperative period, the determination of PAAC allowed in 33.3% of patients to promptly correct the treatment and prevent the development of postoperative infiltrates and abscesses, in the absence of ultrasound signs of inflammation.

Comparison of transabdominal and transvaginal ultrasonography for the assessment of cervical length in the third trimester of pregnancy

ObjectiveThis study aimed to compare TA and transvaginal (TV) ultrasound assessment of cervical length (CL), as well as to assess the feasibility of the TA approach in the third trimester of pregnancy. Materials and methodsThis was prospective study of low-risk women at 31–34 gestational weeks who underwent TA and TV CL measurements during a routine 3rd trimester scan. All examinations were performed by one operator who was blind to the measurements. Differences between the two methods were evaluated. Results240 women were initially enrolled in the study. Paired TA and TV measurements were obtained in 123 (51.3%) women. The mean TV CL was 35.2 ± 6.8 mm and the mean TA CL was 34.7 ± 6.5 mm. There was a significant correlation between the CL measured by the two different methods (r = 0.816). No significant differences were identified between the mean CL measurements of the two techniques (t = −1.360; p = 0.176). Moreover, regarding the feasibility of TA technique, it was less likely to obtain TA CL images in cases with a cephalic fetal presentation (p = 0.028). ConclusionAt 31–34 gestational weeks, with an empty bladder, the cervix can be visualized by the TA approach in only about half of the cases (51.3%). The TA CL measurements show a significant correlation with the TV ones. More research is needed to determine the potential predictive value of the TA ultrasound for preterm labor.

Assessment of Intrafraction Motion of the Urinary Bladder Using Magnetic Resonance Imaging (cineMRI)

AimTo assess the intrafraction motion of the urinary bladder and delineate the appropriate margin size for radiotherapy planning, for both the full and empty bladder. Materials and methodsThis was a single-site, single-arm study of 20 patients planned to undergo radical cystectomy for histologically confirmed muscle-invasive bladder cancer. Patients underwent magnetic resonance imaging (cineMRI) of the entire pelvis using a 3-Tesla system, prior to cystectomy. Patients first underwent a cineMRI with a full bladder, then voided and underwent a second MRI with an empty bladder. All MRI sequences were acquired over 18 min. We assessed the differences in bladder filling and subsequent bladder wall displacement, between the empty and full bladder, during a time period consistent with radiotherapy treatment delivery. ResultsTwenty patients underwent cineMRI of the entire pelvis. The maximum mean directional displacements of the bladder walls over the 18 min duration of the scan for the empty bladders were 9.8 mm superiorly, 1.1 mm inferiorly, 2.39 mm anteriorly, 3.73 mm posteriorly, 2.74 mm to the left and 2.48 mm to the right. The maximal mean displacements for the full bladders were 9.2 mm superiorly, 1.1 mm inferiorly, 2.28 mm anteriorly, 1.08 mm posteriorly, 1.85 mm to the left and 1.73 mm to the right. Statistically significant differences were seen in the posterior, left and right displacements but were quantitatively small. ConclusionsIntrafractional motion secondary to bladder filling showed minimal variation between the full and empty bladder. Similar clinical target volume to planning target volume margins can be applied for the delivery of radiotherapy for a full and empty bladder.

Correlation of transabdominal and transvaginal sonography for the assessment of uterocervical angle at 16–24 weeks’ gestation

The objective of this study was to determine the correlation between transabdominal (TAS) and transvaginal sonography (TVS) uterocervical angle (UCA) measurement in pregnant women with no history of previous preterm birth. A cross-sectional study involving singleton pregnancies between 16 and 24 weeks of gestation who underwent routine foetal anatomical scan was conducted. The TAS-UCA measurement was performed before voiding and with an empty bladder. A total of 256 women completed the sonography. The mean maternal age was 32 ± 6.68 years. The mean gestation age at the time of ultrasound assessment was 19 ± 1.71 weeks. The mean prevoid TAS-UCA was 119.74 ± 33.12° and the mean postvoid TAS-UCA was 110.73 ± 25.30°. There was a significant difference between prevoid and postvoid TAS-UCA measurement (p < .05). The mean TVS-UCA was 103.91 ± 26.42°. The Pearson correlation coefficients of prevoid and postvoid TAS-UCA with TVS-UCA were 0.438 and 0.601, respectively. In conclusion, the postvoid TAS-UCA has moderate correlation with TVS-UCA measurement and is better than the prevoid TAS-UCA in women with low risk for preterm birth.IMPACT STATEMENTWhat is already known on this subject? TVS is the gold standard for cervical length (CL) assessment for prediction preterm birth. However, TVS requires an experienced or trained sonographer and some women decline TVS because of the embarrassment and discomfort during examination. Several studies have demonstrated the correlation between TAS and TVS and suggested that TAS could be an alternative for CL screening. UCA has been reported as a new predictor of spontaneous preterm birth and is usually performed by TVS. Thus, it is interesting to evaluate whether TAS can be a substitute procedure for TVS in UCA measurement.What the results of this study add? TAS may be used as a substitute procedure for TVS and the postvoid TAS is more appropriate than prevoid TAS for UCA measurement.What the implications are of these findings for clinical practice and/or further research? TAS may be an alternative method for UCA measurement when TVS is unavailable or in pregnant women who decline TVS-UCA measurement. However, further study should be conducted to confirm the association between TVS-UCA and postvoid TAS-UCA before deciding to use postvoid TAS-UCA as a screening tool for preterm prediction.

Obstructive voiding symptoms in female patients with overactive bladder syndrome

ObjectivesTo characterize obstructive voiding symptoms (OVS) in patients with overactive bladder (OAB) and normal postvoid residual volume (PVR) and assess their impact on patients' quality of life (QoL) and sexual function. Study designPatients with OAB and normal PVR who visited our urogynecologic clinic between November 2016 and June 2017 were asked to fill a questionnaire comprising of 14 statements regarding Obstructive VOiding Symptoms (the OVOS questionnaire). Patients additionaly completed the UDI-6 and IIQ-7 questionnaires. Statistical analysis was performed to determine the prevalence of each OVS and its correlation with the UDI-6 and IIQ-7 scores. ResultsThirty-eight women enrolled in this study. The OVOS questionnaire was found to have good reliability (Cronbach's alpha = 0.75) and construct validity. Thirty-six (95%) women reported having at least one, while 34 (90%) had at least two, and 31 (82%) had at least three OVS. The statement: `I feel that I am unable to empty my bladder completely` significantly correlated with the sense of frustration (r = 0.44, p = 0.006), as well as with the overall negative impact of urinary incontinence on QoL (r = 0.36, p = 0.03). The statement: `I feel a sensation of fullness immediately after I empty my bladder` significantly correlated with the total impact of urinary incontinence on sexual function (r = 0.42, p = 0.031). ConclusionsMost patients with OAB and normal PVR complain of OVS which may increase the burden on their QoL and sexual function. Some OVS correlate with various segments of the UDI-6 and IIQ-7 questionnaires, suggesting that storage and OVS may share common pathophysiological mechanisms.

Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound.

The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). Twenty women participated, with an average age of 27.95 ± 3.15years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.

Dosimetric comparison of library of plans and online MRI-guided radiotherapy of cervical cancer in the presence of intrafraction anatomical changes

BackgroundOnline magnetic resonance imaging (MRI)-guided radiotherapy of cervical cancer has the potential to further reduce dose to organs at risk (OAR) as compared to a library of plans (LOP) approach. This study presents a dosimetric comparison of an MRI-guided strategy with a LOP strategy taking intrafraction anatomical changes into account.MethodsThe 14 patients included in this study were treated with chemo radiation at our institute and received weekly MRIs after informed consent. The MRI-guided strategy consisted of treatment plans created on the weekly sagittal MRI with 3 mm and 5 mm planning target volume (PTV) margin for clinical target volume (CTV) cervix-uterus (MRI_3mm and MRI_5mm). The plans for the LOP strategy were based on interpolations of CTV cervix-uterus on pretreatment full and empty bladder scans. Dose volume histogram (DVH) parameters were compared for targets and OARs as delineated on the weekly transversal MRI, which was acquired on average 10 min after the sagittal MRI.ResultsFor the MRI_5mm strategy D98% of the high-risk CTV was at least 95% for all weekly MRIs of all patients, while for the LOP and MRI_3mm strategy this requirement was not satisfied for at least one weekly MRI for 1 and 3 patients, respectively. The average reduction of the volume of the reference dose (95% of the prescribed dose) as compared to the LOP strategy was 464 cm3 for the MRI_3mm strategy, and 422 cm3 for the MRI_5mm strategy. The bowel bag constraint V40Gy < 350 cm3 was violated for 13 patients for the LOP strategy and for 5 patients for both MRI_3mm and MRI_5mm strategy.ConclusionsWith online MRI-guided radiotherapy of cervical cancer considerable sparing of OARs can be achieved. If a new treatment plan can be generated and delivered within 10 min, an online MRI-guided strategy with a 5 mm PTV margin for CTV cervix-uterus is sufficient to account for intrafraction anatomical changes.Trial registrationNL44492.018.13.

Clinical score predictive of abdominal leak point pressure (ALPP)

ObjectiveThe aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). Study designWe performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. ResultsWe studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60–90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. ConclusionsPresence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.

Is bladder blood flow an etiologic factor for the bladder pain syndrome?

Bladder pain syndrome (BPS) is a complex disease which causes cognitive, behavioral, sexual, and emotional problems. Vascular factors related to bladder blood supply may be one of the etiologic cause of BPS. This study aims to investigate the bladder blood flow and internal iliac artery resistive indices of patients with BPS. A total of 30 female patients with the diagnosis of BPS and 30 female as control group were enrolled in the study. Bilateral internal iliac arterial blood flow distal to uterine arteries were examined as the primary source of vesical arterial blood supply. Peak systolic velocities, end diastolic velocities, resistive indices, and flow volumes of internal iliac arteries were measured by color Doppler ultrasonography in a single-blind fashion. The blood flows volume of the right and left internal iliac arteries during empty and full bladder were significantly lower at BPS group compared with control (P < 0.05). Although the difference was not significant, the mean resistive index of right and left internal iliac arteries were lower at the control group ( P > 0.05). Aging decreased the bladder blood volume and both BPS and control group internal iliac artery blood volume decreased by aging. The decrease was more significant at the control group, but the internal iliac artery blood volume was still lower at patients with BPS compared with the control group. Arterial blood flow of bladder was lower at patients with BPS compared with the control group. The decrease in the vascular supply of bladder might be one of the related factors for the BPS etiology.

Geometric and dosimetric impact of anatomical changes for MR-only radiation therapy for the prostate.

PurposeWith the move towards magnetic resonance imaging (MRI) as a primary treatment planning modality option for men with prostate cancer, it becomes critical to quantify the potential uncertainties introduced for MR‐only planning. This work characterized geometric and dosimetric intra‐fractional changes between the prostate, seminal vesicles (SVs), and organs at risk (OARs) in response to bladder filling conditions.Materials and methodsT2‐weighted and mDixon sequences (3–4 time points/subject, at 1, 1.5 and 3.0 T with totally 34 evaluable time points) were acquired in nine subjects using a fixed bladder filling protocol (bladder void, 20 oz water consumed pre‐imaging, 10 oz mid‐session). Using mDixon images, Magnetic Resonance for Calculating Attenuation (MR‐CAT) synthetic computed tomography (CT) images were generated by classifying voxels as muscle, adipose, spongy, and compact bone and by assignment of bulk Hounsfield Unit values. Organs including the prostate, SVs, bladder, and rectum were delineated on the T2 images at each time point by one physician. The displacement of the prostate and SVs was assessed based on the shift of the center of mass of the delineated organs from the reference state (fullest bladder). Changes in dose plans at different bladder states were assessed based on volumetric modulated arc radiotherapy (VMAT) plans generated for the reference state.ResultsBladder volume reduction of 70 ± 14% from the final to initial time point (relative to the final volume) was observed in the subject population. In the empty bladder condition, the dose delivered to 95% of the planning target volume (PTV) (D95%) reduced significantly for all cases (11.53 ± 6.00%) likely due to anterior shifts of prostate/SVs relative to full bladder conditions. D15% to the bladder increased consistently in all subjects (42.27 ± 40.52%). Changes in D15% to the rectum were patient‐specific, ranging from −23.93% to 22.28% (−0.76 ± 15.30%).ConclusionsVariations in the bladder and rectal volume can significantly dislocate the prostate and OARs, which can negatively impact the dose delivered to these organs. This warrants proper preparation of patients during treatment and imaging sessions, especially when imaging required longer scan times such as MR protocols.