Bladder Shape Research Articles

Excretory urography can track down morphological changes in the urinary bladder associated with urachal anomalies in calves for early diagnosis.

To investigate radiographic detection by excretory urography of morphological changes in the urinary bladder associated with urachal anomalies in calves. Excretory urography was performed to detect morphological changes in the urinary bladder of 13 calves, of which 6 were nondysuric with swelling of umbilical region and 7 were dysuric without clinical umbilical swelling from November 2022 through April 2024. The urinary bladder was delineated in all 13 calves after excretory urography. The aspect ratios (length:height), which objectively evaluate the shape of the urinary bladder, ranged from 1.08 to 2.43 (1.90 in average) and 1.34 to 11.89 (4.75 in average) in nondysuric and dysuric calves, respectively. The ratios of calves with nondysuric were significantly lower than those of dysuric (P < .05). Excretory urography could play an important role in evaluating abnormal morphological changes due to urachus anomalies in the urinary bladder of calves. Among calves with dysuria, urachal anomaly should be included in the differential diagnosis. Excretory urography is proposed as an alternative option for early diagnosis among calves presenting with dysuria to improve livestock productivity.

Adaptive radiotherapy for muscle invasive bladder cancer: a retrospective audit of two bladder filling protocols

BackgroundRadical radiotherapy for muscle-invasive bladder cancer (MIBC) is challenging due to large variations in bladder shape, size and volume during treatment, with drinking protocols often employed to mitigate geometric uncertainties. Utilising adaptive radiotherapy together with CBCT imaging to select a treatment plan that best fits the bladder target and reduce normal tissue irradiation is an attractive option to compensate for anatomical changes. The aim of this retrospective study was to compare a bladder empty (BE) protocol to a bladder filling (BF) protocol with regards to variations in target volumes, plan of the day (PoD) selection and plan dosimetry throughout treatment.MethodsForty patients were included in the study; twenty were treated with a BE protocol and twenty with a BF protocol to a total prescribed dose of 55 Gy in 20 fractions. Small, medium and large bladder plans were generated using three different CTV to PTV margins. Bladder (CTV) volumes were delineated on planning CTs and online pre-treatment CBCTs. Differences in CTV volumes throughout treatment, plan selection, PTV volumes and resulting dose metrics were compared for both protocols.ResultsMean bladder volume differed significantly on both the planning CTs and online pre-treatment CBCTs between the protocols (p < 0.05). Significant differences in bladder volumes were observed between the planning CT and pre-treatment CBCTs for BF (p < 0.05) but not for BE (p = 0.11). Both protocols saw a significant decrease in bladder volume between first and final treatment fractions (p < 0.05). Medium plans were preferentially selected for BE whilst when using the BF protocol the small plan was chosen most frequently. With no significant change to PTV coverage between the protocols, the volume of body receiving 25.0–45.8 Gy was found to be significantly smaller for BE patients (p < 0.05).ConclusionsThis work provides evidence in favour of a BE protocol compared to a BF protocol for radical radiotherapy for MIBC. The smaller treatment volumes observed in the BE protocol led to reduced OAR and total body doses and were also observed to be more consistent throughout the treatment course. These results highlight improvements in dosimetry for patients who undergo a BE protocol for MIBC.

Intelligent Bladder Volume Monitoring for Wearable Ultrasound Devices: Enhancing Accuracy Through Deep Learning-Based Coarse-to-Fine Shape Estimation.

Accurate and continuous bladder volume monitoring is crucial for managing urinary dysfunctions. Wearable ultrasound (US) devices offer a solution by enabling noninvasive and real-time monitoring. Previous studies have limitations in power consumption and computation cost or quantitative volume estimation capability. To alleviate this, we present a novel pipeline that effectively integrates conventional feature extraction and deep learning (DL) to achieve continuous quantitative bladder volume monitoring efficiently. Particularly, in the proposed pipeline, bladder shape is coarsely estimated by a simple bladder wall detection algorithm in wearable devices, and the bladder wall coordinates are wirelessly transferred to an external server. Subsequently, a roughly estimated bladder shape from the wall coordinates is refined in an external server with a diffusion-based model. With this approach, power consumption and computation costs on wearable devices remained low, while fully harnessing the potential of DL for accurate shape estimation. To evaluate the proposed pipeline, we collected a dataset of bladder US images and RF signals from 250 patients. By simulating data acquisition from wearable devices using the dataset, we replicated real-world scenarios and validated the proposed method within these scenarios. Experimental results exhibit superior improvements, including +9.32% of IoU value in 2-D segmentation and -22.06 of RMSE in bladder volume regression compared to state-of-the-art (SOTA) performance from alternative methods, emphasizing the potential of this approach in continuous bladder volume monitoring in clinical settings. Therefore, this study effectively bridges the gap between accurate bladder volume estimation and the practical deployment of wearable US devices, promising improved patient care and quality of life.

Bladder height to width ratio as a surrogate marker for non-physiological storage pressures in children with spinal dysraphism.

Spinal dysraphism is the most frequent cause of neurogenic bladder. Urodynamic study (UDS) is an important component of the follow-up of a child with neurogenic bladder. However, it suffers from a lack of widespread availability and is further hampered by technical difficulties and difficulty in its interpretation in children. A neurogenic bladder often appears vertically elongated; only limited and sparse literature is available regarding objectively defining the bladder shape and the urodynamic parameters in the cohort. This study aimed to investigate the usefulness of the bladder's height-to-width ratio (HWR) on cystogram as a screening tool for identifying "non-physiological" bladder pressures in children with spinal dysraphism. A prospective study was undertaken to evaluate children operated for spinal dysraphism. Cystogram, ultrasonography and UDS evaluation were performed. HWR was calculated by the ratio of the maximum height to the maximum bladder width at maximum cystometric capacity (MCC), where MCC was calculated using standard Koff's formula, given by (age in years + 2) *30ml in children more than one year and weight *7ml for infants. The children were categorised into groups based on maximum detrusor pressure (MDP) into two groups (MDP ≥ 30cmH2O and MDP < 30cmH2O). A receiver-operative characteristic curve was constructed to analyse the sensitivity and specificity of HWR in predicting the MDP. A total of 53 children, operated for spinal dysraphism, met the study criteria during the study period, from March 2021 to September 2022. The median age of children was 4years (IQR-3-5.5years). The HWR ratio was compared between the two groups and was significantly higher for the non-physiological pressure bladders than for physiological pressure bladders (mean of 1.55 vs 1.26, p = 0.001). On evaluating the sensitivity and specificity of HWR for discerning children with non-physiological bladder pressures were 87.5% and 48.28%, respectively. The area under the curve (AUC) was 0.781, with a cut-off value of 1.3. We attempted to evaluate the HWR based on bladder shape objectively. We demonstrated a moderate correlation between the bladder shape and the bladder pressures. An HWR of 1.3 or higher could be significant for identifying a non-physiological bladder storage pressure. The height to width ratio of the bladder on cystogram is a useful tool as a surrogate marker for non-physiological storage pressures in bladders of children with spinal dysraphism.

Novel use of contrast enhanced ultrasonography with urodynamics in children: A comparison study to fluoroscopy.

Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (ceVUS) has rarely been reported for use with UDS. This is the first study to compare the imaging characteristics of ceVUS versus fluoro UDS. Children were enrolled for ceVUS UDS who previously underwent fluoro UDS. Demographics, imaging data for ceVUS and fluoro UDS, time between studies, and clinical data between studies were recorded. Changes in clinical status included implantation/cessation of catheterization or anticholinergic medications, leakage between, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar's Chi-Squared and Wilcoxon matched-pairs signed rank test. Seventy-five children were recruited. Median time between studies was 1.3 years (IQR 0.9-2.9). There were no differences for bladder shape (p = 0.59), vesicoureteral reflux (p = 0.10), bladder neck (p = 0.59) or urethra (p = 1.0) between studies. In 5 cases, the bladder neck could not be visualized adequately due to layering of the microbubble contrast against urine. Benefits to ceVUS included ability to visualize the exact moment the bladder neck opened. Following exclusion of patients with clinical changes that might affect imaging findings, an analysis of 28 patients demonstrated no differences between the two studies. CeVUS can be used adequately in conjunction with UDS. Limitations to ceVUS include more granular imaging for bladder shape versus fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with ceVUS.

The Interplay of Proteinuria and Cachexia from the Perspective of Persian Medicine (PM)

Chronic kidney disease (CKD) impacts approximately 15-20% of adults globally and is identified as an independent risk factor for non-alcoholic fatty liver disease (NAFLD). NAFLD is associated with cardiovascular disease (CVD) and poses a threatening condition as it is becoming a major public health concern in connection with metabolic syndrome (1). Due to the connection it has with several metabolic disorders, proteinuria - the detection of proteins excreted in the urine - is gaining prevalence with the increase of chronic diseases such as CKD, diabetes mellitus, hypertension, brain strokes, preeclampsia, cancer, and obesity. Normal urinary protein excretion is less than 150 mg/24 hours and consists mostly of secreted proteins. The normal mean albumin excretion rate (AER) is 5-10 mg/day, with an AER of more than 30 mg/day considered abnormal. Poor kidney and cardiovascular outcomes are caused by structural damage to the glomerular filtration barrier. Proteinuria often manifests clinically in the forms of cachexia, foamy urine, and edema (2). The term Cachexia (kak-ex-ee-a) comes from the Greek words “Kakos” (meaning bad) and “Hexis” (meaning condition). Characterized by a hypercatabolic state that alters the body’s utilization of proteins, carbohydrates, and fats in the context of a chronic inflammatory response, cachexia is defined as the accelerated loss of skeletal muscle and is distinct from ordinary weight loss. What exactly happens in cachexia is still a mystery to scientists due to its complex process that involves several organs and systems in the body. Cachexia manifests in individuals with chronic illnesses, such as cancer, heart failure, cirrhosis, and hepatic or renal failure. Foamy urine is an indicator of protein in the urine (2). Food, when digested by the liver, is converted into secondary metabolites, a collection of substances that are called Humor in PM. The process of food digestion is divided into four stages: gastric, hepatic, vascular, and tissue metabolism. Disturbance in any of these four stages can lead to the production of bad humors and eventually cause diseases, such as su-ol-qonyeh which corresponds to cachexia in terms of clinical symptoms and refers to widespread tissue damage throughout the body caused by chronic diseases, such as heart failure and chronic liver and kidney disease. Su-ol-qonyeh, when advanced, develops into a disease called Estesqua - equivalent to Ascites - which is categorized into different types. As stated in PM resources, these diseases share similar symptoms with proteinuria, such as foam in the urine and edema in various degrees appearing in different organs. In the past, a method of diagnosis used by PM physicians was to examine the patient’s urine in a glass container made in the shape of a human bladder, called a Qarooreh . Foamy urine was seen in the same way in some diseases. By comparing these two points of view, it can be concluded that chronic diseases caused by underlying factors trigger the release of pathogenic mediators and tissue damage. PM states that these predisposing factors are divided into two categories: cold and hot. Treatment and drug selection are based on this division, and the treatment protocols differ for each patient (3). Taking PM into consideration when treating patients, especially those with proteinuria accompanied by weight loss, edema, or ascites, not only helps the process but also provides a basis for further research and improvement in the prevention and control of these diseases.

Early ontogenetic development of Cynodon gibbus (Characiformes: Cynodontidae) in the Amazon River basin

Abstract Knowledge regarding the early life history of neotropical fish, although incipient, is crucial for the accurate identification of larvae collected from the natural environment. Such details are important for defining spawning, drift, and nursery areas as well as the reproductive periods of species. Herein, the larval development of Cynodon gibbus was described using morphological, meristic, and morphometric characteristics. Specimens were collected from open water limnetic zones and under macrophyte stands in the Amazon basin from 2010 to 2023. Forty-eight larvae with standard lengths ranging from 5.73 to 21.57 mm were studied. The larvae have a long to very long body, small eyes, and a small head, which progresses to a moderate size in the preflexion stage. Furthermore, the larvae had ample mouths with numerous conical teeth, an oval-triangular swim bladder, overlapping dorsal and anal fins, and the tip of the pectoral fin not reaching the swim bladder. Pigmentation pattern comprised two punctate pigments above the fontanelle, the rectum, and at the lower and upper ends of the caudal peduncle. Various body parts exhibited predominant allometric relationships, reflecting differential developmental rates among them in response to fundamental ecological requirements for survival. The C. gibbus larvae can be identified by a combination of the position of dorsal, anal and pectoral fins, pigmentation pattern, swim bladder shape, and the total number of myomeres (51 to 53).

Comparative Mitogenomics Reveals Cryptic Species in Sillago ingenuua McKay, 1985 (Perciformes: Sillaginidae).

It is unreliable to identify marine fishes only by external morphological features. Species misidentification brings great challenges to fishery research, resource monitoring and ecomanagement. Sillago ingenuua is an important part of commercial marine fishes, and in which, the morphological differences between different groups are not obvious. Here, we compared different geographical groups of S. ingenuua which were collected from Xiamen, Dongshan, Keelung, Songkhla and Java. The results showed that all samples of S. ingenuua were similar in external morphological characteristics and the shape of the swim bladder, but there were two distinctive lineages which were flagged as cryptic species based on DNA barcoding. The comparative mitogenomic results showed that S. ingenuua A and S. ingenuua B were identical in structural organization and gene arrangement. Their nucleotide composition and codon usage were also similar. A phylogenetic analysis was performed based on 13 concatenated PCGs from eight Sillago species. The results showed that the genetic distance between S. ingenuua A and S. ingenuua B was large (D = 0.069), and this genetic distance was large enough to reveal that S. ingenuua A and S. ingenuua B might be different species.

Diving into dual functionality: Swim bladder muscles in lionfish for buoyancy and sonic capabilities.

Although the primary function of the swim bladder is buoyancy, it is also involved in hearing, and it can be associated with sonic muscles for voluntary sound production. The use of the swim bladder and associated muscles in sound production could be an exaptation since this is not its first function. We however lack models showing that the same muscles can be used in both movement and sound production. In this study, we investigate the functions of the muscles associated with the swim bladder in different Pteroinae (lionfish) species. Our results indicate that Pterois volitans, P. radiata and Dendrochirus zebra are able to produce long low-frequency hums when disturbed. The deliberate movements of the fin spines during sound production suggest that these sounds may serve as aposematic signals. In P. volitans and P. radiata, hums can be punctuated by intermittent louder pulses called knocks. Analysis of sonic features, morphology, electromyography and histology strongly suggest that these sounds are most likely produced by muscles closely associated with the swim bladder. These muscles originate from the neurocranium and insert on the posterior part of the swim bladder. Additionally, cineradiography supports the hypothesis that these same muscles are involved in altering the swim bladder's length and angle, thereby influencing the pitch of the fish body and participating in manoeuvring and locomotion movements. Fast contraction of the muscle should be related to sound production whereas sustained contractions allows modifications in swim bladder shape and body pitch.

Assessment of Bladder Filling Type on Radiation Dose to Organs at Risk in MR-Guided Intracavity Brachytherapy for Cervical Cancer

In this study, we evaluated whether the classification of bladder shape affects the absorbed dose (Gy) of OARs and its geometrical position to normal organs in MR-guided intracavitary brachytherapy (ICBT). In this study, 269 patients who underwent MR-guided ICBT for cervical cancer from 2016 to 2022 were included. The applicator-inserted bladder filling type (BFT) classification was divided into three types (tilted, curved, and other shapes: group E). The anatomical positional relationship between the uterus and its surroundings was measured on pre-MR images and ICBT simulation MR images. Spearman's rank correlation analysis was used for bladder volume and OAR dose according to BFT. Anatomical differences were analyzed by ANOVA by measuring the distance from the center to both bladder walls. In the correlation analysis considering the shape of the bladder, the tilted, curved, and group E had Spearman's ρ of 0.211; -0.323, 0.412; -0.307 and -0.035; -0.209 for maximum absorbed dose (D2cc) of bladder and small bowel, respectively. It was statistically significant in the tilted type and curved type. The average left and right bladder lengths differences of the tilted type were the highest at 8.47 cm and 7.11 cm, respectively. It was a statistically significant between bladder shape and the difference in left and right bladder lengths differences (p< 0.01). In this study, it was confirmed that bladder distension increased the maximum bladder dose (D2cc) and decreased the maximum bowel dose (D2cc) to the tilted type and curved type. In addition, if the left and right bladder lengths are measured in pre-MR, the degree of bladder distension can be evaluated in advance by checking the shape of the bladder in the case of the tilting type before ICBT. Based on these findings, a prospective study is needed to evaluate the effect of ICBT on cervical cancer treatment outcomes through bladder type classification.

Mechanisms of action of an intravesical balloon as a therapy for stress urinary incontinence

Aims:Previous studies have indicated that the intravesical placement of an air-filled balloon alleviates much of the symptoms caused by stress urinary incontinence (SUI) in women. However, the exact working mechanisms behind this therapy are not yet fully understood. The current study aims to elucidate the potential physiological mechanisms underlying this minimally invasive intervention. Methods:We have evaluated video urodynamic data in women undergoing this therapy (n = 5), during which participants were asked to cough with increasing intensity. For each participant, we have videos before insertion of the balloon and one week following insertion. We identified a frame in a resting situation in which the maximum horizontal and vertical bladder dimensions were measured. We expressed the maximum vertical diameter as a ratio of the maximum horizontal diameter. We then used custom-written scripts to identify the bladder and balloon in each frame of the video urodynamic investigation and subtracted information regarding the location of the bladder neck and diameters of the balloon. We then used this information to plot the displacement of the bladder neck and size of the balloon during coughing. Results:The diameters of the balloon were significantly decreased during coughing (p ≤ 0.05). We found a significant increase of the maximum vertical diameter expressed as a ratio of the maximum horizontal diameter before and after insertion of the intravesical balloon (p ≤ 0.05). The maximum displacement of the caudal bladder limit increased significantly after placement of the intravesical balloon was (p ≤ 0.05). Conclusions:Our results imply that the balloon compresses in response to increases in abdominal pressure, and the bladder obtains a significantly more vertically oriented shape after placement of the balloon. Moreover, it appears that placement of the balloon significantly increases the mobility of the bladder neck. The balloon is indicated to absorb some of the increases in intravesical pressure during episodes of high abdominal pressure. We propose that the balloon inwardly pushes the bladder wall upwards, causing the organ to acquire a more vertically oriented shape. Additionally, we postulate that this change in bladder shape will increase the mobility of the bladder neck, thereby increasing the kinking capability of the urethra.

Research priorities for diagnostic instrumentation in urinary incontinence.

The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.

Weakly supervised learning-based 3D bladder reconstruction from 2D ultrasound images for bladder volume measurement.

Accurate measurement of bladder volume is necessary to maintain the consistency of the patient's anatomy in radiation therapy for pelvic tumors. As the diversity of the bladder shape, traditional methods for bladder volume measurement from 2D ultrasound have been found to produce inaccurate results. To improve the accuracy of bladder volume measurement from 2D ultrasound images for patients with pelvic tumors. The bladder ultrasound images from 130 patients with pelvic cancer were collected retrospectively. All data were split into a training set (80 patients), a validation set (20 patients), and a test set (30 patients). A total of 12 transabdominal ultrasound images for one patient were captured by automatically rotating the ultrasonic probe with an angle step of 15°. An incomplete 3D ultrasound volume was synthesized by arranging these 2D ultrasound images in 3D space according to the acquisition angles. With this as input, a weakly supervised learning-based 3D bladder reconstruction neural network model was built to predict the complete 3D bladder. The key point is that we designed a novel loss function, including the supervised loss of bladder segmentation in the ultrasound images at known angles and the compactness loss of the 3D bladder. Bladder volume was calculated by counting the number of voxels belonging to the 3D bladder. The dice similarity coefficient (DSC) was used to evaluate the accuracy of bladder segmentation, and the relative standard deviation (RSD) was used to evaluate the calculation accuracy of bladder volume with that of computed tomography (CT) images as the gold standard. The results showed that the mean DSC was up to 0.94 and the mean absolute RSD can be reduced to 6.3% when using 12 ultrasound images of one patient. Further, the mean DSC also was up to 0.90 and the mean absolute RSD can be reduced to 9.0% even if only two ultrasound images were used (i.e., the angle step is 90°). Compared with the commercial algorithm in bladder scanners, which has a mean absolute RSD of 13.6%, our proposed method showed a considerably huge improvement. The proposed weakly supervised learning-based 3D bladder reconstruction method can greatly improve the accuracy of bladder volume measurement. It has great potential to be used in bladder volume measurement devices in the future.

Ontogeny of the swim bladder of the Plainfin Midshipman, Porichthys notatus (Percomorphacea: Batrachoidiformes)

The batracoidid Plainfin Midshipmen Porichthys notatus Girard has been extensively studied due to the sound production abilities and specializations of its swim bladder. The present study describes three-dimensional variations of the morphology of the swim bladder and sonic muscles of P. notatus during its post-hatch larval development, with the use of three-dimensional computed tomography. This study also includes descriptions of the relative position of the swim bladder to other visceral organs. The swim bladder, digestive tract, and liver were already present in the smallest examined specimens (5.9 mm; newly hatched larvae) along with the yolk sac. In the smallest specimens, the digestive tract is straight, but from 7.1 mm TL, the digestive tract forms the first intestinal loops, and at 25.5 mm TL, a second intestinal loop. In smallest specimens, the swim bladder is oval, but at 7.1 mm TL, the anterior margin starts invaginating, forming a pair of anterior lobes. The first appearance of the intrinsic sonic muscles in swim bladder occurs at 13.1 mm TL. Additionally, we provide comparisons between the shape of the swim bladder of P. notatus and other species. The shape of the swim bladder of P. notatus and other members of Porichthyinae have an ovoid posterior region with two anterior lobes and differs from the cordiform or semiconected/bilobed the swim bladders observed in the other Batrachoididae.

PD37-05 USE OF CONTRAST ENHANCED ULTRASONOGRAPHY WITH URODYNAMICS: A COMPARISON STUDY TO FLUOROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD37-05 USE OF CONTRAST ENHANCED ULTRASONOGRAPHY WITH URODYNAMICS: A COMPARISON STUDY TO FLUOROSCOPY Emmett H. Kennady, Sean T. Corbett, Susan Leroy, Kathryn Morgan, Reza Daugherty, Nicole Kapral, and Nora G. Kern Emmett H. KennadyEmmett H. Kennady More articles by this author , Sean T. CorbettSean T. Corbett More articles by this author , Susan LeroySusan Leroy More articles by this author , Kathryn MorganKathryn Morgan More articles by this author , Reza DaughertyReza Daugherty More articles by this author , Nicole KapralNicole Kapral More articles by this author , and Nora G. KernNora G. Kern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (CeVUS) has been in use to evaluate for genitourinary anomalies but has not been known to be used in conjunction with UDS. We evaluated the ability, quality of using CeVUS UDS and compared the results with fluoro UDS. METHODS: Children ages 0-18 were enrolled for CeVUS UDS who previously underwent fluoro UDS. Demographic data, imaging data for CeVUS and fluoro UDS, time in between studies, and clinical data between studies were recorded. Changes in clinical status between the 2 studies included changes in catheterization, urine leakage between, anticholinergic medications, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar’s Chi-Squared and Wilcoxon matched-pairs signed rank test. RESULTS: 53 children were recruited with none declining the study. Table 1 contains demographics and clinical changes between studies. Median time between studies was 1.3 years (IQR 0.9 - 2.9). 53 CeVUS UDS studies were completed with adequate data; none were aborted due to technical reasons. In 4 cases, the bladder neck could not be visualized accurately due to non-mixing and layering of the microbubble contrast against urine (Table 1). Benefits to CeVUS included ability to visualize the exact moment the bladder neck opened. There were no significant differences in bladder shape, presence of vesicoureteral reflux, bladder neck or urethral changes in the cohort at differing time points. Following exclusion of patients with significant changes in medication regimen, catheterization, neuro procedures, hydronephrosis, and UTIs that could lead to changes in UDS imaging findings, a subgroup analysis of 25 patients demonstrated no significant differences in parameters between the 2 studies. CONCLUSIONS: CeVUS can be used adequately in conjunction with urodynamics. Slight limitations to CeVUS include more granular imaging for bladder shape compared to fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with CeVUS. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e987 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emmett H. Kennady More articles by this author Sean T. Corbett More articles by this author Susan Leroy More articles by this author Kathryn Morgan More articles by this author Reza Daugherty More articles by this author Nicole Kapral More articles by this author Nora G. Kern More articles by this author Expand All Advertisement PDF downloadLoading ...

Encephalitozoon cuniculi Infection of Domestic Rabbits (Oryctolagus cuniculus) in Slovenia between 2017 and 2021.

Encephalitozoon cuniculi is a microsporidial parasite that primarily infects domestic rabbits (Oryctolagus cuniculus). It is the causative agent of encephalitozoonosis, a disease with an internationally recognized seroprevalence among rabbits. This study determines the presence, clinical manifestation, and serological status of encephalitozoonosis in pet rabbits in Slovenia using various diagnostic procedures. From 2017 to 2021, 224 pet rabbit sera were collected and tested for encephalitozoonosis with the indirect immunofluorescence assay. Immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against E. cuniculi were confirmed in 160 (65.6%) cases. Most seropositive rabbits suffered from neurological clinical signs or signs of gastrointestinal disorders such as recurrent hypomotilities, chronic weight loss, cachexia, or anorexia, and fewer showed clinical signs related to the urinary system or phacoclastic uveitis. A quarter of the positively tested rabbits presented without clinical signs. Hematological and biochemical blood analysis confirmed that seropositive animals had elevated globulin and deviated albumin levels in comparison to the normal reference values of non-infected animals. Furthermore, rabbits with neurological clinical signs showed statistically significant higher levels of globulins and total protein. Sixty-eight whole-body radiographs and thirty-two abdominal ultrasound reports were analyzed, looking for changes in the shape or size of the urinary bladder, presence of urinary sludge or uroliths, and any abnormalities related to the kidneys (shape, size, or nephrolites). The results suggest that neurological defects in the urinary bladder caused by E. cuniculi lead to a distended urinary bladder and consequently dysuria, incontinence, urine scalding, and sludgy urine.

Bladder deformity accompanied by pelvic fracture indirectly indicates clinical severity

BackgroundThat the bladder can be compressed by extraperitoneal hematoma induced by obstetrics and gynecologic diseases, is well known. However, there have been no reports on the clinical significance of compressed bladder induced by pelvic fracture (PF). We therefore retrospectively investigated the clinical features of compressed bladder induced by the PF. MethodsFrom January 2018 to December 2021, we performed a retrospective review of the hospital medical charts of all emergency outpatients who were treated by emergency physicians at the department of acute critical care medicine in our hospital, and who were diagnosed with PF based on computed tomography (CT) on arrival. The subjects were divided into two groups: the Deformity group, in which the bladder was compressed by extraperitoneal hematoma, and the Normal group. Variables were compared between the two groups. ResultsDuring the investigation period, 147 patients with PF were enrolled as subjects. There were 44 patients in the Deformity group and 103 in the Normal group. There were no significant differences between the two groups with regard to sex, age, GCS, heart rate or final outcome. However, the average systolic blood pressure in the Deformity group was significantly lower, and the average respiratory rate, injury severity score, rate of unstable circulation, rate of transfusion and duration of hospitalization in the Deformity group were significantly greater in comparison to the Normal group. ConclusionsThe present study showed that bladder deformity induced by PF tended to be a poor physiological sign that was associated with severe anatomical abnormality, unstable circulation requiring transfusion, and long hospitalization. Accordingly, physicians should evaluate shape of bladder when treating PF.

Static Stability and Swim Bladder Volume in the Bluegill Sunfish (Lepomis macrochirus).

Static stability is a property inherent to every organism. More stable bodies benefit from a lower energy cost associated with maintaining a desired orientation, while less stable bodies can be more maneuverable. The static stability of a fish is determined by the relative locations of its center of mass (COM) and center of buoyancy (COB), which may change with changes in swim bladder volume. We hypothesized, however, that fish would benefit from consistent static stability, and predicted that changes in swim bladder volume would not alter the overall pattern of COM and COB locations. We used micro-computed tomography to estimate the locations of the COM and COB in bluegill sunfish (Lepomis macrochirus). Using this technique, we were able to find a small but significant difference between the location of the COM and COB for a given orientation. We found that the swim bladder can change shape within the body cavity, changing relative locations of the COM and COB. At one extreme, the COB is located 0.441±0.007 BL from the snout and 0.190±0.010 BL from the ventral surface of the pelvic girdle, and that the COM is 0.0030±0.0020 BL posterior and 0.0006±0.0005 BL ventral to the COB, a pattern that causes a nose-up pitching torque. At the other extreme, the COM is anterior and dorsal to the COB, a pattern that causes the opposite torque. These changes in location seems to be caused by changes in the shape and centroid location of the swim bladder within the body: The centroid of the swim bladder is located significantly more posteriorly in fish oriented head-down. The air in the bladder "rises" while heavier tissues "sink," driving a change in tissue distribution and changing the location of the COM relative to the COB. Supporting our hypothesis, we found no correlation between swim bladder volume and the distance between the COM and COB. We conclude that bluegill are statically unstable, requiring them to expend energy constantly to maintain their normal orientation, but that the pitch angle of the body could alter the relative locations of COM and COB, changing their static stability.

Fetal bladder morphology may predict neonatal outcomes in fetal lower urinary tract obstruction (LUTO)

Objectives: To evaluate postnatal survival outcomes of severe LUTO-affected fetuses based on fetal bladder shape. We hypothesize that fetuses with a “floppy” appearing bladder on initial prenatal ultrasound will have worse neonatal outcomes than fetuses with full/rounded bladders. Study Design: We performed a retrospective case review of all cases of LUTO that were evaluated for fetal intervention in a single large fetal center between January 2013 and December 2021. Fetuses were given a “favorable” or “unfavorable” evaluation based on comprehensive ultrasound, renal biochemistry testing, and bladder refill testing. Favorable evaluations were offered fetal intervention with vesicoamniotic shunt placement. Baseline demographics, ultrasound parameters, prenatal renal function testing, and neonatal outcomes were collected. Those with a diagnosis of severe LUTO were included in analysis. Descriptive statistics were used to analyze candidate data. Primary outcome was survival at 6 months of life. Results: Of the 104 LUTO patients evaluated, 24 were included in analysis. Details of prenatal evaluations are shown in Table 1a; six-month survival among groups based on fetal bladder morphology are shown in Table 1b. Postnatal survival at six months in patients with rounded bladders was 60% overall. Fetuses with floppy bladders showed a 0% six-month overall survival, which was significantly lower (p=0.002) as compared with the full/rounded bladder group. Conclusions: We propose that analysis of bladder shape in fetuses with severe LUTO may be an important prognostication factor for predicting neonatal outcomes. This simple, non-invasive assessment may inform clinical decision-making regarding further testing or fetal intervention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Use of statistical shape modeling to enhance the fluoroscopic evaluation of the bladder

IntroductionVideo urodynamic studies (VUDS) use fluoroscopic imaging to visualize the bladder and multichannel urodynamics to assess its function. Qualitative assessment of bladder shape is used to identify abnormal features (e.g., diverticula) that correspond with pathophysiology; however, this assessment is limited in its ability to predict bladder function. Therefore, we developed a novel quantitative approach to assess bladder shape obtained from fluoroscopic VUDS images utilizing statistical shape modeling. This method was compared to existing binary and continuous shape quantification methods and used to identify relationships between bladder shape and measures of bladder physiology categorized as related to sensation, incontinence, or emptying.MethodsThis was a retrospective, cross-sectional study of 49 participants. Bladder walls were segmented from fluoroscopic images at rest with the bladder filled to approximately 300 mL. Bladder shape was evaluated in three ways: 1) binary categorization as typical or atypical based on clinical assessment, 2) quantification of height-to-width ratios, and 3) quantification by statistical shape modeling. Independent t-tests and correlations were used to assess associations between the three shape evaluation methods and to define relationships between shape and physiologic measures: 3 volumetric measures describing sensation, 2 dichotomous variables addressing incontinence, and 1 volumetric measure representing emptying.ResultsThe statistical shape model generated 5 modes of variation. Mode 1 corresponded with height-to-width ratio (r=0.920, p&amp;lt;0.001), modes 2 and 3 with diagonal height-to-width ratio (r=0.66 and -0.585, p&amp;lt;0.001 and &amp;lt;0.001), and mode 3 with binary shape categorization (p&amp;lt;0.001). In terms of function, those with atypical bladder shape had impaired emptying (p=0.010), modes 4 and 5 were significantly associated with measures of bladder sensation, mode 3 with urodynamic stress urinary incontinence, and mode 3 with emptying in those able to void (r=0.368, p=0.021). The relationship between mode 3 and emptying across all patients is best fitted by a quadratic function (p&amp;lt;0.001).DiscussionOur results demonstrate that binary shape categorization and bladder shape quantified by statistical shape modeling correspond with measures of bladder physiology. This foundational study establishes statistical shape modeling as a robust bladder shape quantification method that can be used to relate bladder shape with physiology.