Measurement Of Bladder Wall Thickness Research Articles

Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction

Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45±4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p=0.049, r=-0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58±0.68mm in the NC group and 2.18±1.35mm in the LC group (p=0.044). Left lateral wall thickness was 1.45±0.44mm in the NC group and 2.02±1.4mm in the LC group (p=0.033). Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.

Sonographic Prevalence of Lower Urinary Tract Infection among Out and in Patients in Biosensors Medical Diagnostics Wuse II Abuja Metropolis: A Case Study of Those Presented for Bladder Ultrasound

Introduction: Two hundred outpatients were recruited for the study only sixty-five (65) of them were used from those who presented for bladder ultrasound. Masmed F5 4D ultrasound machine with a curvilinear transducer at 3.5MHz of frequency was used for the study. Pre and post void urinary bladder volume, anterior and posterior bladder wall thickness measurements were made on 65 healthy asymptomatic outpatients. There was no statistically significant difference between anterior and posterior bladder wall thickness (P>0.05) however there was a statistical significant difference between pre-void and post-void urine volume (P<0.05). Females were more prevalent in the study population than males with higher bladder wall thickness (BWT) consistent with lower urinary tract infection, the sonographic prevalence of urinary bladder retention was 8(12.31%), consisting of a male (1.54%) and females 7(10.77%) In line with bladder outlet obstruction (BOO) assessed at 5% level of significance. The sonographic prevalence of lower urinary tract infection in Biosensors medical diagnostics Wuse ll Abuja was 32.5% when assessed at the 5% level of in-significance (P>0.05), and it was most prevalent in individuals between the ages of 26 and 30. In Nigeria, it is advised that lower urinary tract infections should be diagnosed and treated early in both males and females.

Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement.

Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder?

ABSTRACTObjective:Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children.Patients and Methods:A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3.Results:The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2).In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB.Conclusions:Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.

Correlation of Urethral Ratio and Bladder Wall Thickness with Cystoscopic Findings in Posterior Urethral Valve Patients to Assess Residual Valves.

Introduction:Posterior urethral valve (PUV) is life threatening congenital anomaly of urinary tract. Aim of the study was to correlate urethral ratio (UR) and bladder wall thickness (BWT) with cystoscopic findings in PUV patients to assess residual valves and to validate UR as a diagnostic tool for residual valves. It also aimed to assess the utility of bladder wall thickness in diagnosis of residual valves.Materials and Methods:A total of 31 patients were included in the prospective study done from 2017 to 2019. Calculation of UR was done in oblique VCUG films by dividing maximum posterior and anterior urethral diameter without the catheter insitu. Measurement of BWT was done at dome and bladder neck at full distension with feeding tube insitu and was done at same volume in follow up. The procedure was repeated at 3 months follow up. The findings were compared with cystoscopic findings for the status of residual valves as gold standard. Each patient served as control for self in the study.Results:Median age of presentation was 1 years with range of 1day to 10 years. The most common complains at the time of presentation in our study was straining (35.48%) followed by antenatally diagnosed patients (25.81%) and recurrent UTI (19.36%). Pre fulguration median UR was 2.45. Post Fulguration median UR was 1.20. It showed a statistically significant reduction (p < 0.001) after fulguration. Pre fulguration median BWT was 4 mm. Post fulguration median BWT was 2.5 mm. BWT showed a statistically significant reduction (p < 0.001) after fulguration as well. ROC curve was plotted for UR and BWT. BWT more than 1.95 mm (sensitivity-80%) and UR more than 1.2 (sensitivity-70%) indicates residual valves.Conclusion:A step ladder approach including BWT, UR and check cystoscopy can serve as a new diagnostic algorithm for the assessment of residual valves thereby avoiding extra radiation and general anesthesia exposure.

The Evaluation of Posterior Urethrovesical Angle, Urethral Length, Bladder Wall Thickness, and Residual Volume with Transperineal Ultrasonography in Women with Urinary Incontinence

Objective: In the recent decades, transperineal ultrasonography has been used to examine patients in urogynaecology practice. In this study, we aimed to evaluate the function of transperineal ultrasonography in women with urinary incontinence.Methods: Forty-five patients who were admitted to our institution between December 2012 and May 2013 and clinically and urodynamically diagnosed as having urinary incontinence (SUI n=20, DI+UUI n=13, MUI n=12) were included in the study. Additionally, 25 clinically and urodynamically continent women were included as the control group. The patients were evaluated using transperineal ultrasonography (USG) in the supine position during rest and straining. An abdominal probe was placed in the perineum vertically and sagittally; when the symphysis pubis, urethra, bladder, vagina, and rectum could be seen clearly on the monitor, the image was frozen. Posterior urethrovesical angle (PUVA), urethral length, bladder wall thickness, and residual urine volume were measured on the image. All measurements were compared statistically between the SUI, UUI, MUI groups, and control group. The post-void residual volume measured using transperineal ultrasonography was compared with the post-void residual volume measured using a catheter during urodynamics.Results: PUVA was significantly different in the SUI and MUI groups at rest than in the control group (p&amp;lt;0.05). During Valsalva maneuvers, PUVA was statistically significantly different in the SUI and MUI groups than in the UUI and control groups (p&amp;lt;0.01). Conclusion: The measurement of PUVA and bladder wall thickness by transperineal ultrasonography is shown to be useful in diagnosis of patients with suspected detrusor instability and structural defects in pelvic floor. Therefore, transperineal USG may be an easy and reliable method which could be an alternative to urodynamic studies in patients who cannot undergo urethral catheterization.

Gall Bladder Wall Thickness as a Predictor for Laparoscopic Cholecystectomy Difficulties in Gadarif, Eastern Sudan

Background: Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Multiple studies have identified factors that are predictive of surgical difficulties including preoperative ultra-sonographic findings.&#x0D; Objective: To determine the effectiveness of sonographic measurement of gall bladder wall thickness as a predictive factor for laparoscopic cholecystectomy difficulties in Gadarif Teaching Hospital, Sudan.&#x0D; Patients and methods: This are a prospective, observational, analytical cross-sectional hospital-based study in which all patients who underwent laparoscopic cholecystectomy for gall stones disease and had a pre-operative sonographic measurement for GBWT in GTH in the year 2019 were included.&#x0D; Results: 110 cases were studied. The male to female ratio was 0.2: 1, the mean age was 35±3.8 years. Past history of the acute attack reported in 54 (48.2%) of the patients, history of ERCP was reported in 2 (1.8%) and the majority of patients 71 (64.5%) has no associated medical condition. Abdominal examination was normal in 69 (62.7%) of the patients, 35 (31.8%) patients showed positive Murphy's sign or other signs. Gall bladder thickening, as a predictor of difficulty, was normal of ≤ 3 mm in 69 (62.7%), mild (4-5 mm) in 34 (30.9%), moderate (6-7 mm) in 5 (4.5%), and severe &gt; 7 in 2 (1.8%) of the patients. A significant association was found between GBWT and: duration of symptoms, the number of attacks, operative time and hospital stay, postoperative complication, and conversion to open cholecystectomy. Operative time was found to be associated with the experience of the operator (P-value &lt; 0.05).&#x0D; Conclusion: Pre-operative sonographic increasing gall bladder wall thickness is associated with difficult laparoscopic cholecystectomy in terms of postoperative complications, prolonged operative time, and conversion to open cholecystectomy even in expert hands.

Can ultrasound measurement of bladder wall thickness be a useful adjunct for regular urodynamics in children with spina bifida?

Spina bifida is a major cause of neurologic bladder dysfunction among children. The goal of neurogenic bladder treatment is to preserve renal function. Close follow-up is essential, as lower urinary tract functions can change with patient growth. Presently, invasive urodynamics is the gold standard for precisely assessing lower urinary tract function. Ultrasound is a low-cost, non-invasive, uncomplicated examination that can be easily repeated. Bladder wall thickness (BWT) measurement by ultrasound has been proposed as a non-invasive alternative for identifying lower urinary tract dysfunctions. Currently there are few reports on BWT in children with spina bifida, and BWT assessment methodology has yet to be defined. The present study aim was to investigate whether BWT could be a useful adjunct for regular urodynamics in children with spina bifida. We especially focused on the precise bladder volume during BWT measurements that were simultaneously performed with urodynamics. This prospective observational study investigated 33 patients with spina bifida who underwent video urodynamics. We assessed BWT measurements using ultrasound simultaneously performed with video urodynamics. BWT was calculated for the ventral and dorsal walls at 0%, 20%, 40%, 60%, 80%, and 100% of the expected bladder capacity. Median of bladder capacity was 240mL, and bladder compliance was 19.2 mL/cmH2O. Detrusor overactivity was present in 66.7% and vesicoureteral reflux was present in 27.3% of the patients. BWT of the ventral wall was significantly lower than the dorsal wall. During increases in the bladder volume, both the ventral and dorsal walls exhibited proportional thinning (p<0.05). There were no significant differences for BWT between males and females. Although there was a higher statistical tendency for detrusor overactivity versus without detrusor overactivity (p=0.085), there were no significant differences found between patients with and without detrusor overactivity. This is the first report where multiple BWT measurements points with video urodynamics were simultaneously performed. Selection of bladder volumes for BWT measurements is critical. Our current study measured six points for each patient during urodynamics. However, available data was not sufficient for detecting bladder function. Until now, there has been no valid standard condition defined for measuring BWT and thus, lack of a standardized method has resulted in discrepancies among studies. Our measurement conditions showed BWT may not correlate with the degree of bladder detrusor dysfunction. As BWT ultrasound cannot identify bladder dysfunction of children with spina bifida, this cannot be used as a substitute for invasive urodynamics.

Presurgical bladder wall thickness is a useful marker to predict the postsurgical improvement of symptoms in patients with pelvic organ prolapse-related overactive bladder.

ObjectivesPelvic organ prolapse (POP) is a cause of overactive bladder (OAB), and transvaginal mesh (TVM) surgery can improve the symptoms. Bladder wall thickness (BWT) is a useful and safe marker to evaluate bladder function in urinary disorders. The main purpose of this study is to clarify the relationship between BWT and changes in the OAB symptom score (OABSS) after TVM operation in patients with POP.MethodsBWT was measured by ultrasonography before and 6 months after surgery at three sites in the bladder: the anterior wall, trigone, and dome. Similarly, the OABSS was evaluated at the time of BWT measurement. Changes induced in BWT at each site and the mean BWT at all sites after TVM surgery were analyzed. Similarly, the relationship between presurgical BWT and the decrease in OABSS was investigated.ResultsTVM surgery improved OABSS in 30 patients (responders; 73.2%), while 11 patients were judged as nonresponders (26.8%). BWT at the anterior bladder wall and dome as well as the mean BWT at all three sites were significantly decreased by TVM surgery (P < .001). Similar trends were identified in OABSS responders; however, all markers showed no significant changes in OABSS nonresponders. All the BWT‐related markers before surgery were significantly lower in OABSS responders than in OABSS nonresponders.ConclusionsBWT at the bladder anterior wall and dome, but not the trigone, were decreased by TVM surgery. We conclude that presurgical BWT may be a useful marker to predict the improvement in OAB symptoms by TVM surgery in patients with POP‐related OAB.

Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

Background: Preoperative prediction of a difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for intraoperative risk and the risk of conversion to open Cholecystectomy. Aim of study: Evaluation the impact of gall bladder wall thickness, on the outcome of laparoscopic cholecystectomy and conversion rate to open cholecystectomy assessed by sonography preoperative and postoperative measurement of gall bladder wall thickness by histopathology. Patients and Methods: A prospective study conducted in the surgical unit, Department of surgery, Baghdad Teaching Hospital between November 2010 and November 2011. Abdominal Sonography performed in 110 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic finding in operative room, and postoperatively, the gall bladder specimens were sent for histopathological measurement of wall thickness. Results: Out of 110 patients with cholecystolithiasis on sonography, we encountered easy laparoscopic cholecystectomy in 80 patients (72.7%), difficult laparoscopic cholecystectomy in 24 (21.8%) and the procedure was converted to open cholecystectomy in six patients (5.5%). The difference between Sonographic and histological measurement was within 1 mm in 102 patients (92.7%), and the other 8 patients was with 1.5 mm (7.3%) with sensitivity of (100%), specificity of (83.3%) and accuracy of (97%). Conclusion: An accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gall bladder surgery to provide information for the selection of the most appropriate approach and avoid intraoperative difficulties and surprises. On sonography gall bladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.

Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia.

Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. To study the relationship among BWT, PVR, and BEE in BPH. A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.

Interrater reliability of bladder ultrasound measurements in children

Bladder ultrasound is becoming pivotal in the management and treatment of lower urinary tract dysfunction. There is a paucity of data regarding intra-observer and interobserver reliability of bladder ultrasound, especially in children. A previous study assessed interobserver agreement for both the postvoid residual volume and measurement of the bladder dimensions in adults showing excellent agreement. To examine the interobserver and intra-observer reliability of bladder wall thickness, bladder urinary and postvoid residual urinary volume using ultrasound evaluated by paediatricians having different training levels. Four sonographers, 3 pediatric trainees and one experienced pediatric urologist measured the full bladder volume, the voiding residual volume, and the bladder wall thickness. Each sonographer made 3 measurements of each parameter. We assessed the interobserver and intra-observer variability by using intraclass correlations (ICCs). ICCs were calculated and tested with a significance level of 5%. The interrater ICC was calculated from the mean of the three measurements of each variable (full bladder volume, postvoid residual, bladder wall thickness). ICC ≥0.75 was considered excellent. Bland-Altman plots were also used to assess the interobserver agreement. Sixty children were recruited (7.3±1.1 years). The interobserver ICCs for bladder volume and voiding residual volume were 0.91 (confidence interval 0.85-0.95) for both. The interobserver ICCs for the bladder wall thickness was satisfactory 0.43, with a minimum detectable difference of 2mm. The observed values for intra-observer analysis showed an excellent (ICC≥0.90) agreement between the three measurements performed by each one of the sonographers. Bland-Altman plots showed that the bias (mean difference) was -0.35 and the limits of agreement were -3.43 and 2.73 for the bladder wall thickness measurements (Figure). The interobserver reliability for both the postvoid residual volume and full bladder volume were excellent even in operators with different levels of training, pointing out the role of bladder ultrasound in the routine clinical practice. Weaker agreement was found for the bladder wall thickness measurement. The intra-observer agreement was excellent for all the measurements. These results showed a good reliability of urinary bladder ultrasound in children aged 7.3±1.1 years as far as bladder volume measurement is concerned. Given the variability of bladder wall thickness, a standardized methodology is desirable to increase its reliability.

Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease

Background/aims: Esophageal varices (EV) are common complications in patients with advanced chronic liver disease (ACLD). Non-invasive parameters to exclude EV in patients with ACLD would be desirable. The aim of this study was the evaluation of liver stiffness measurement (LSM) using 2D-shear wave elastography (GE Logiq E9) and other non-invasive parameters as predictors for EV.Methods: Hundred patients with ACLD were enrolled. Abdominal sonography, including measurement of gall bladder wall thickness (GBWT), spleen diameter and LSM, gastroscopy and blood test results were evaluated. Statistical analyses were performed for the association between EV and non-invasive parameters.Results: Fifty-one per cent of the patients had EV. The mean LSM (14.6 kPa) and GBWT (3.88 mm) in the group with EV were significantly higher than in the group without EV (10.6 kPa; 2.94 mm; p < .01). Performing area under the receiver operating characteristic curve, LSM has a better diagnostic performance (0.781) than GBWT (0.707), spleen diameter (0.672) and platelet count (0.635). Combining LSM (cut-off 13.58 kPa) and GBWT (cut-off 3.07 mm) resulted in a sensitivity of 86.3% and a specificity of 71.4% for the presence of EV. A sensitivity of 100% (negative predictive value 1.0) was achieved at LSM >9 kPa or GBWT >4 mm. Following these criteria in our current study population, 18% of the gastroscopies could have been avoided.Conclusions: Combining LSM with non-invasive parameters, especially GBWT, improves the diagnostic accuracy for predicting EV. We suggest reconsidering screening gastroscopy in patients with ACLD who show LSM <9 kPa and GBWT <4 mm due to the very low risk of having varices.

The urethral closure function status in pregnant women suffering from overactive bladder syndrome

The ultrasound method of investigation was proposed as the first step in the diagnosis of urinary incontinence, since the average value of the thickness of the bladder wall and the size of the urethral sphincter in the works of many urologists are correlated with the presence of overactive bladder. The objective: was to determine the sonographic parameters of the urethral closure in pregnant women with overactive urinary bladder. Materials and methods. In this article, an estimation of such ultrasound signs of the urethral closure apparatus, such as funnel-like urethral enlargement, bladder wall thickness measurement, bladder volume, residual urine volume, were performed. The diagnostic value of the cervical-bulk test in pregnant women with overactive urinary bladder is assessed. The obtained results were compared with the same in healthy pregnant women. Results. The index of bladder wall thickness with age increases, as in women with overactive bladder, and in practically healthy women. However, significantly higher value of this indicator (p&lt;0,001) was found in the group of women with overactive bladder. In the third trimester of pregnancy, a positive cervical-bleb test was found in all patients with overactive bladder. In the group of pregnant women with overactive bladder, significantly less volume of the bladder and increased volume of residual urine, which confirms the world data. Conclusion. Data of spontaneous contractions of detrusor in pregnant women suggest that this indicator is a characteristic diagnostic feature of overactive bladder. Key words: pregnancy, ultrasound examination, urethral closure, overactive bladder.

Validation study of ultrasound bladder wall thickness measurements.

The aim was to validate ultrasound bladder wall thickness measurements. We scanned at three frequencies (5MHz, 7MHz and 9MHz), using two techniques described in clinical practice and compared them with direct micrometre calliper measurements. Bladder dome cadaver specimens were dissected from male and female cadavers. The direct micrometre calliper measurement under direct vision was used as the gold standard. We imaged using a Voluson E8 ultrasound scanner at three frequencies, using three probes: AB27D (2-7MHz), RAB25D (2-5MHz) and RIC50D (5-9MHz). The specimens were scanned on two different occasions for intra-observer variability. A second operator, measured the samples again independently for the interobserver agreement. The specimens were gently placed onto a sheathed and gelled probe to avoid deformation. The method of scanning was the same for all the specimens, probes and operators. Twenty-five bladder dome specimens were assessed. The correlation of the ultrasound measurement to the direct measurement improved at higher ultrasound frequencies. Measuring from the inside of the serosal hyperechogenicity also increased the accuracy correlation with the direct measurement for all the frequencies tested. This is the first study validating BWT ultrasound measurements against cadaveric bladder wall calliper measurements. Technology and technique affect accuracy, which is important in clinical practice. The use of 5-MHz probes is not recommended. The most accurate measurement was obtained using high-frequency ultrasound, where the measurement did not include the serosal brightness. These data suggest that high-frequency ultrasound should be used to assess BWT.

Subtle errors of bladder wall thickness measurement have a significant impact on the calculation of ultrasound-estimated bladder weight. A pilot study.

Ultrasound-estimated bladder weight (UEBW), is an emerging diagnostic tool, which has been used in both malesand females with lower urinary tract dysfunction. The currently acknowledged UEBW calculation methods rely on the accuratemeasurement of bladder wall thickness (BWT). We aim to identify if subtle errors in BWT measurement have a significantimpact on UEBW calculations. Twenty patients were randomly selected from an overactive bladderpatient cohort. The primary endpoint was to identify the range of false BWT measurements outside which significant changesin UEBW calculation occur. We used the Kojima method and a semi-automatic 3-D model that is based on Chalana's principle. Measurements were performed using the correct BWT and a series of faulty calculations from +0.5 mm to -0.5 mm using stepsof 0.05 mm from true BWT. The effect of a fixed 0.5 mm BWT error was checked in bladder volumes above and below 250 mland in three UEBW groups (<35 gr; 36-50 gr; >51gr). BWT measurement errors above 0.25 mm cause statistically significant changes in UEWB calculation when a 3-D model is used and errors above 0.15 mm when Kojima's method is used.At a fixed BWT error of 0.5 mm and bladder volume <250 ml, there is a 23.76% deviation from true UEBW, while at volumes>250 ml the deviation is 32.72%. The deviation is inversely proportional to the UEBW result, and heavier bladders deviateless. UEBW is a promising diagnostic tool, but small errors in BWT measurement might cause significant deviationfrom the true values. A 3-D calculation model appears to minimize such risks.

MP39-10 NOVEL CONTRAST MIXTURE ACHIEVES CONTRAST RESOLUTION OF HUMAN BLADDER WALL SUITABLE FOR T1 MAPPING: APPLICATIONS IN INTERSTITIAL CYSTITIS (IC) AND BEYOND

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis1 Apr 2018MP39-10 NOVEL CONTRAST MIXTURE ACHIEVES CONTRAST RESOLUTION OF HUMAN BLADDER WALL SUITABLE FOR T1 MAPPING: APPLICATIONS IN INTERSTITIAL CYSTITIS (IC) AND BEYOND Pradeep Tyagi, Joe Janicki, Chan-Hong Moon, Jonathan Kaufman, and Christopher Chermansky Pradeep TyagiPradeep Tyagi More articles by this author , Joe JanickiJoe Janicki More articles by this author , Chan-Hong MoonChan-Hong Moon More articles by this author , Jonathan KaufmanJonathan Kaufman More articles by this author , and Christopher ChermanskyChristopher Chermansky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Instillation of novel contrast mixture (NCM) was recently shown to improve the contrast resolution of rat bladder wall with high contrast-to-noise ratio (CNR). Here, the clinical safety and the feasibility of NCM enhanced MRI to achieve artifact-free visualization of human bladder wall suitable for quantitative measurement of the magnetic resonance (MR) longitudinal relaxation time (T1) was accessed. METHODS Six female subjects [2 controls and 4 IC] consented for MRI at 3T before and after instillation of NCM [4mM Gadobutrol and 5mM Ferumoxytol in 50mL of sterile water for injection]. Respiratory monitoring belt was placed under the receiver coil for monitoring the breath-hold. Single breath hold fast MR acquisition from 5mm thick single slice in large readout bandwidth at variable flip angles was applied to minimize the motion and chemical shift artifacts in the measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. RESULTS Subjects did not complain of any pain or discomfort from 50mL NCM instillation, beyond that caused by the catheterization process. Four-fold increase in bladder wall CNR (*p<0.02) and spatial resolution of 0.35mm with minimal influence of artifacts made it feasible to determine the significant bladder wall thinning of ~0.46mm (*p<0.05) from 50mL NCM. Pre-contrast bladder wall T1 of 1544± 34.2ms was shortened by Gadobutrol diffusion into the bladder wall to 860.09 ±13.95 ms in Hunner type IC (*p<0.0001, two way ANOVA) relative to only 1257.42± 20.59 ms and 1258.16 ± 6.16ms in non-Hunner type IC and controls, respectively. Post-contrast pixel-wise T1 mapping differentiated the bladder wall into layers with greater Gadobutrol mediated T1 shortening in pixels representing the urothelium and lamina propria (blue and green) compared to the detrusor region (yellow in attached picture). CONCLUSIONS Recapitulation of the published pre-clinical findings in the clinical setting demonstrates the safety and feasibility of NCM enhanced MRI to achieve artifact-free differential contrast and spatial resolution of human bladder wall, which is suitable for first pixel-wise measurement of T1 in both pre-and post-contrast settings. Quantitative T1 measurement holds promise in the non-invasive characterization of diffuse pathophysiological changes in bladder wall of IC patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e513-e514 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Pradeep Tyagi More articles by this author Joe Janicki More articles by this author Chan-Hong Moon More articles by this author Jonathan Kaufman More articles by this author Christopher Chermansky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Novel contrast mixture achieves contrast resolution of human bladder wall suitable for T1 mapping: applications in interstitial cystitis and beyond.

Instillation of novel contrast mixture (NCM) was recently shown to improve the contrast resolution of rat bladder wall with high contrast-to-noise ratio (CNR). Here, the clinical safety and the feasibility of NCM-enhanced MRI to achieve artifact-free visualization of human bladder wall suitable for quantitative measurement of the magnetic resonance (MR) longitudinal relaxation time (T1) was assessed. Six female subjects [two controls and two with Hunner-type interstitial cystitis ICand two with non-Hunner-type IC] consented for MRI at 3T before and after instillation of NCM [4mM gadobutrol and 5mM ferumoxytol in 50mL of sterile water for injection]. Single breath-hold fast MR acquisition in large readout bandwidth for 5-mm-thick single slice with variable flip angle was applied to minimize the motion and chemical shift artifacts in measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. NCM instillation in subjects did not evoke pain or discomfort. Fourfold increase in bladder wall CNR (*p<0.02) and pixel size of 0.35mm with minimal influence of artifacts allowed accurate determination of bladder wall thinning~0.46mm from 50mL NCM (*p<0.05). Pre-contrast bladder wall T1 of 1544±34.2ms was shortened to 860.09±13.95ms in Hunner-type IC (*p<0.0001) relative to only 1257.42±20.59 and 1258.16±6.16ms in non-Hunner-type IC and controls, respectively. Findings demonstrate the safety and feasibility of NCM-enhanced MRI to achieve artifact-free differential contrast and spatial resolution of human bladder wall, which is suitable for measuring BWT and pixel-wise measurement of T1 in post-contrast setting.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome.

ABSTRACTObjectiveThe main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients.Materials and MethodsThe patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated.ResultsThe mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002).ConclusionThe results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

Reproducibility of the transvaginal sonographic assessment of bladder wall thickness

ObjectiveTo assess whether transvaginal sonographic measurements of bladder wall thickness (BWT) have adequate reproducibility to detect differences in BWT potentially indicative of detrusor overactivity in women with overactive bladder. Study designThree reproducibility studies were undertaken to assess (A) total measurement error, (B) intra-observer variability and (C) inter-observer measurement in the interpretation of scans. Women recruited to the Bladder Ultrasound Study underwent a transvaginal ultrasound scan to obtain a measurement of BWT. When a second observer was available, women who agreed to have two transvaginal scans by different operators were recruited into study A. For study B the first observer reassessed a sample of the recorded images at a later date whilst for study C, a random selection of BWT images were read by a second assessor. Analytical variability, percentage of variability attributable to measurement error, within-person variation and the smallest real difference detectable were estimated. ResultsOne hundred and twenty-one women took part: 27 had repeat scans, 37 had scans re-read by the same observer, and 57 had scans read by two observers. In study A, 39% of the total variability in measurements was explained by measurement error (the remainder to within person change); the standard deviation (SD) of measurement error was 0.76mm and the smallest detectable clinical difference was 2.1mm. The SD of measurement error from scan interpretation was 0.42mm within observers (study B) and 0.35mm between observers (studyC). ConclusionThe high levels of measurement error for a small measurement of BWT means it is unlikely Transvaginal ultrasound measurements have insufficient reliability and reproducibility to be an accurate diagnostic test.