Ultrasound Bladder Scanner Research Articles

The failure of subcategorization of cauda equina syndrome.

The diagnostic sub-categorization of cauda equina syndrome (CES) is used to aid communication between doctors and other healthcare professionals. It is also used to determine the need for, and urgency of, MRI and surgery in these patients. A recent paper by Hoeritzauer et al (2023) in this journal examined the interobserver reliability of the widely accepted subcategories in 100 patients with cauda equina syndrome. They found that there is no useful interobserver agreement for the subcategories, even for experienced spinal surgeons. This observation is supported by the largest prospective study of the treatment of cauda equina syndrome in the UK by Woodfield et al (2023). If the accepted subcategories are unreliable, they cannot be used in the way that they are currently, and they should be revised or abandoned. This paper presents a reassessment of the diagnostic and prognostic subcategories of cauda equina syndrome in the light of this evidence, with a suggested cure based on a more inclusive synthesis of symptoms, signs, bladder ultrasound scan results, and pre-intervention urinary catheterization. This paper presents a reassessment of the diagnostic and prognostic subcategories of CES the light of this evidence, with a suggested cure based on a more inclusive synthesis of symptoms, signs, bladder ultrasound scan results, and pre-intervention urinary catheterization.

What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States.

The ways that device-associated infection prevention practices changed during the coronavirus disease 2019 (COVID-19) pandemic remain unknown. We collected data mid-pandemic to assess the use of several infection prevention practices and for comparison with historical data. Repeated cross-sectional survey. US acute-care hospitals. Infection preventionists. We surveyed infection preventionists from a national random sample of 881 US acute-care hospitals in 2021 to estimate the current use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated events (VAE). We compared the 2021 results with those from surveys occurring every 4 years since 2005. The 2021 survey response rate was 47%; previous survey response rates ranged from 59% to 72%. Regular use of most practices to prevent CLABSI (chlorhexidine gluconate for site antisepsis, 99.0%, and maximum sterile barrier precautions, 98.7%) and VAE (semirecumbent positioning, 93.4%, and sedation vacation, 85.8%) continued to increase or plateaued in 2021. Conversely, use of several CAUTI prevention practices (portable bladder ultrasound scanner, 65.6%; catheter reminders or nurse-initiated discontinuation, 66.3%; and intermittent catheterization, 37.3%) was lower in 2021, with a significant decrease for some practices compared to 2017 (P ≤ .02 for all comparisons). In 2021, 42.1% of hospitals reported regular use of the newer external urinary collection devices for women. Although regular use of CLABSI and VAE preventive practices continued to increase (or plateaued), use of several CAUTI preventive practices decreased during the COVID-19 pandemic. Structural issues relating to care during the pandemic may have contributed to a decrease in device-associated infection prevention practices.

Accuracy of Bladder Scanner in Measuring Bladder Volumes in Postpartum Women.

Ultrasound bladder scanners may provide a less invasive method to measure postpartum urinary volume, but their accuracy must be validated. The objective of this study was to evaluate the accuracy of a bladder scanner in measuring bladder volumes in postpartum women. The secondary objective was to evaluate the effect of obesity on scanner accuracy. This prospective cohort study included women older than 18 years who gave birth vaginally at term gestation. After delivery, we obtained 3 sequential measurements of the bladder volume using an ultrasound bladder scanner. We then measured true bladder volume by transurethral catheterization. The primary outcome was the absolute difference between the bladder scanner volume and the catheterized volume. A Wilcoxon signed-rank test was used to compare absolute median difference between the bladder scan volume and true catheter volume. Repeated-measures analysis of variance and linear regression were used to evaluate the effect of obesity on the accuracy of the bladder scanner. We enrolled 70 patients (61.4% nulliparous, 38.6% multiparous). One delivery was vacuum-assisted, 4 were forceps-assisted, and 65 were spontaneous vaginal. The median age was 34 years, and median body mass index was 30.5. Median difference between bladder scanner and catheter volume was 42.7 mL (P < 0.001), with the scanner underestimating true volume 82.9% of the time. The scanner was less accurate in patients with a body mass index ≥ 30 (P = 0.001). The bladder scanner is less accurate than catheterized urine volume. However, the median difference between the bladder scanner and the catheterized volume is 42.7 mL, making it suitable for clinical use. Accuracy deteriorates in obese patients.

Validation of acoustic voided volume measure: a pilot prospective study.

We evaluated the accuracy and reliability of a new smartphone-based acoustic voided volume (VV) measurement application compared to VV estimation based on the measurement of urine volume in a bladder by ultrasound bladder scan. A total of 53 subjects from 01/2021 to 09/2021 were prospectively enrolled. Bladder scan-based VV estimation is based on the difference in the volume of urine in a bladder measured before urination and volume measured after urination. The acoustic VV measurement is based on smartphone-based acoustic VV measurement mobile application. VV estimates for the same void were compared between two techniques. Urinary measures were obtained from 49 male subjects resulting in a total of 245 measurements for analysis. VV measures were compared using Pearson's correlation coefficient (PCC), evaluation of observed versus predicted VV measures using linear regression fit indices, and Bland-Altman method. VV between the two techniques revealed strong correlation (PCC 0.811, p < 0.001). Means of the number of measurements per patient and inpatient days for measurements analyzed are 5 and 2.7, respectively. In 245 measurements, VV measured by bladder scan is 238.69 ± 122.32mL, VV measured by mobile application is 254.69 ± 119.28mL, and their difference of two measurements is 16 ± 74.29mL. Through the comparison with VV estimated by ultrasound bladder scan, which is a technology to measure the urine volume in a bladder, it was confirmed that the smartphone-based acoustic VV measurement application proudP® is accurate.

Status of hospital infection prevention practices in Thailand in the era of COVID-19: Results from a national survey

BackgroundA 2014 study assessed infection prevention (IP) practices in Thai hospitals for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). This study compares current IP practices to results obtained in 2014. MethodsBetween February 1, 2021 and August 31, 2021, we resurveyed Thai hospitals regarding practices to prevent CAUTI, CLABSI, and VAP. We also assessed COVID-19 impact and healthcare worker burnout and coping strategies. We distributed 100 surveys to a convenience sample of infection preventionists. ResultsResponse rate: 100%. One-third (31%) of hospitals reported excellent leadership support for infection control (ie, responses of “good” or “excellent” to one survey question). Some prevention practices increased between 2014 vs 2021 (CAUTI: catheter reminder/stop-order/nurse-initiated discontinuation [50.0% vs 70.0%, P < .001]; condom catheters [36.3% vs 51.0%, P = .01]; ultrasound bladder scanner [4.7% vs 12.0%, P = .03]; CLABSI: chlorhexidine gluconate insertion site antisepsis [73.6% vs 85.0%, P = .03]; maximum sterile barrier precautions [63.2% vs 80.0%, P = .003]; VAP: selective digestive tract decontamination [26.9% vs 40.0%, P = .02]). Antimicrobial catheter use decreased since 2014 (10.4% vs 3.0%, P < .001). Many other practices remain suboptimal. COVID-19 challenges: staff shortages (71%), financial hardships (67%). Only 46% of infection preventionists felt safe working during COVID-19. ConclusionsMore national strategic support is needed for IP programs to prevent CAUTI, CLABSI, VAP and healthcare worker well-being in Thailand during the COVID-19 pandemic.

Can portable ultrasound bladder scanner be applied to young children less than three years old?

The bladder scanner (BS), a portable ultrasound device specialized in bladder volume measurement, has been developed and applied to clinical assessment of postvoid residual urine, which is a requisite in evaluating patients with voiding dysfunction. However, experiences in the application of the BS to the pediatric population remain limited despite commonly encountered reluctance to catheterization. This prospective observational study aimed to evaluate the correlation and accuracy of the newly developed pediatric module of the BS (BioCon-900) in measuring bladder volume in children 0-6 years old. This study included 29 patients scheduled to undergo preventive untethering for their spinal dysraphism. When they undergo cystometry for the confirmation of normal neurologic function, bladder volume was measured by BS when recorded volume infusion reached each quartile of the age-adjusted estimated bladder capacity (EBC). The difference (bias) between measured and infused volume was expressed as a percentage of EBC (%EBC). The correlation coefficient and the Bland-Altman plot were obtained to determine the discriminating power and accuracy, respectively. The acceptable limit was set as 30%EBC. A strong correlation between the measured and infused volume (r=0.95, P<0.001) was found for the entire age range. This excellent correlation remained comparable between children less than three years and the older ones. Bladder volume tended to be overestimated, and the mean bias was 33±22.3%EBC, and it became higher with increasing quartiles. The accuracy was acceptable in all ranges of measurement in the older group and first and second quartiles in the younger one. We have first evaluated the potential use of BS in 0-3 years old children and compared the results with 4-6-year-old children in whom the accuracy of BS has been demonstrated. The strong point of our study was the inclusion of data spanning all quartiles of bladder volume. The use of infused volume as reference enabled us to assess the accuracy in a more precise way than the use of ultrasound. Despite the good discriminating power, the accuracy was not acceptable in higher quartiles in the younger group. If the trend of overestimation especially higher volume, could be understood prior to measurement, it would be helpful to assume the real val. The children's module in BS showed excellent discriminating power and generally acceptable accuracy in more than four-year-old children. This may lose accuracy in higher quartiles among less than three years old children.

Improvement in bladder volume reproducibility using A-mode portable ultrasound bladder scanner in moderate-hypofractionated volumetric modulated arc therapy for prostate cancer patients.

PurposeThis study introduced an A‐mode portable ultrasound bladder scanner, the Lilium® α‐200 (here after Lilium; Lilium Otsuka, Kanagawa, Japan), for the treatment of prostate cancer patients with hypofractionated volumetric modulated arc therapy to improve the reproducibility of bladder volume (BV).Materials and methodsThirty patients were advised to maintain full BV prior to computed tomography (CT) simulation and daily treatment. Among these, the BV of 15 patients was measured using Lilium until a BV of 80% in the simulation was achieved (with the Lilium group). Daily cone‐beam CT (CBCT) was performed for treatment. The correlation between BV measured by CBCT and Lilium was assessed. The differences in the BV and dosimetric parameters of the bladder in the CBCT versus planning CT were compared between the groups with and without Lilium.ResultsThere was a significantly strong relationship (r = 0.796, p < 0.05) between the BVs measured using CBCT and Lilium. The relative BV ratios to simulation CT < 0.5 and > 2 were observed in 10.3% and 12.7%, respectively, of treatment sessions without Lilium group, while these ratios were 1% and 2.8%, respectively, in the Lilium group. The mean absolute difference in the range of V30Gy to V40Gy without Lilium sessions was significantly larger (p < 0.05) than that in the Lilium group.ConclusionThe use of the A‐mode portable ultrasound bladder scanner significantly improved the reproducibility of the BV, resulting in few variations in the dosimetric parameters for the bladder.

Evaluation of an ultrasound bladder scanner in supine and standing position.

PurposeThis study examined the performance of a bladder volume measuring device, the BladderScan (BS) BVI9400. The use of the BS offers the possibility of assessing the bladder volume before positioning the patient and performing the daily image‐guided radiotherapy procedure. Patients often cannot lie down before entering the treatment vault. Therefore, the BS was also assessed in a standing position.MethodsThe repeatability precision was first evaluated, which is the variability of immediate repeated measures of the BS with same operator and subject. This was followed by the reproducibility precision of the BS in which the operator and subjects differ. Finally, the trueness was evaluated in terms of fixed and proportional bias of the results by applying weighted least‐squares fitting. Note that 53 and 85 patient measurements were carried out in supine and standing position, respectively, each consisting of three repeated BS measurements. These were compared with the computed tomography (CT)‐delineated bladder volume.ResultsRepeatability was dependent on measurement value (heteroscedasticity) with σ repeatability (BS) = ±15 cm3 ± 10%. However, the total agreement between BS and CT was low with the 95% limits of agreement (LOAs) exceeding ±200 cm3 due to poor patient reproducibility and presence of fixed and proportional bias. Only in the best case of male patients in the supine position, three BS measurements, and correction for the fixed and proportional bias, 95% LOAs of [–147, +114] cm3 were obtained between CT and BS.ConclusionThe agreement of the BVI9400 BS with CT was found to be too low for radiotherapy applications.

The usefulness of uroflowmetry and ultrasound bladder scanning as diagnostic tools in primary care for new male patients with lower urinary tract symptoms; a cluster randomized controlled trial.

Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists. To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care. A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months. Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5). Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.

Assessment of an ultrasound bladder scanner in prostate radiotherapy: A validation study and analysis of bladder filling variability.

During prostate radiotherapy treatment, it is important to ensure the position of the bladder and prostate is consistent between treatments. The aim of this study was to provide a quantitative basis for incorporating ultrasound bladder volume estimates into local practice for prostate radiotherapy. Agreement between bladder volume estimates obtained using computed tomography (CT) and ultrasound was assessed. Analysis of bladder volumes between planning and treatment scans was used to quantify expected variations in bladder volume over the course of radiotherapy. Dose-volume statistics were estimated and compared to planned dose constraints to propose a target bladder volume and tolerance. Bladder volume measurements were obtained from 19 radiotherapy patients using ultrasound and CT. Ultrasound underestimated bladder volume compared to CT with a mean bias of -28 ± 30 ml. Pre-treatment (planning) bladder volumes varied from 71 to 383 ml with a mean of 200 ml. Treatment bladder volumes reduced by more than half in 9% of patients during the course of their treatment, potentially leading to a 30% increase in mean bladder dose. Patients with pre-treatment bladder volumes < 200 ml were most likely to exhibit differences in bladder volume, resulting in 'out of tolerance' increases in dose. A pragmatic individualised drinking protocol, aimed at achieving a minimum ultrasound bladder volume of 200 ml at planning CT, may be beneficial to reproducibility in radiotherapy treatment. Ultrasound measurements prior to treatment should ideally confirm that bladder volume is at least half the volume measured at planning.

Comparative accuracy of the Lilium α-200 portable ultrasound bladder scanner and conventional transabdominal ultrasonography for postvoid residual urine volume measurement in association with the clinical factors involved in measurement errors.

We examined the comparative accuracy of the portable ultrasound bladder scanner, Lilium α-200, and conventional ultrasonography (CUS) in bladder volume measurement. We also examined factors that could lead to measurement errors. Postvoid residual (PVR) volume was measured by Lilium α-200 and CUS with catheterized volume as a comparator in 224 consecutive men,of which 109 were also measured for the serially inflated bladder with saline. The measurement accuracy with respect to the actual volume was evaluated by calculating the error volume (EV), % error volume (%EV), and their absolute values. Absolute %EV of≤20% wasdesignated as nonerror. The measurement of prostate volume, abdominal thickness, and pelvimetry was performed on magnetic resonance images. PVR volumes measured by CUS are better correlated with actual volumes (r = .779) than those of Lilium α-200 (r = .606). When the measurement accuracy was indicated by absolute values of EV and %EV, CUS provided a more accurate estimate (21 ± 21 ml, 60 ± 42%) than Lilium α-200 (32 ± 45 ml, 91 ± 142%). The frequency of error was significantly increased at lower bladder volumes. Overestimation was associated with larger prostate size for the Lilium α-200, while underestimation was associated with greater bladder flattening for both methods. PVR volumes measured by Lilium α-200 were fairly correlated with actual volumes. However, their relative errors were too large to correctly predict the actual volume. Flattened bladder and a large prostate may hinder accurate measurements. Consequently, Lilium α-200 is not superior to CUS and its feasibility is limited to when the precise measurement is not required.

Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital.

Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 ± 1.0 per patient), with a mean age of 57.0 ± 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 ± 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.

Applying Team Resource Management to Reduce the Urinary Catheter Usage Rate in Our Intensive Care Unit

According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.

Assessing Postvoid Residual to Identify Risk for Urinary Complications Post Stroke.

After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important. This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL. Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan. Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications. Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.

Subjective versus objective determination of bladder emptying following urogynecological surgery: "do you feel that you completely emptied your bladder?"

We tested the hypothesis that women can subjectively determine if they have emptied their bladder after a spontaneous voiding attempt following urogynecological surgery to rule out post-operative urinary retention as determined by a voiding trial. This is a prospective observational study of women undergoing urogynecological surgery at two academic institutions from June 2016 to March 2019. Following surgery, subjects underwent a voiding trial followed by measurement of the PVR via ultrasound bladder scan or straight catheterization. A successful voiding trial was defined as a PVR of ≤150ml. Subjects were queried about their subjective sensation of bladder emptying; "Do you feel that you completely emptied your bladder?" Their responses were either "Yes", "No" or "I don't know". Their subjective responses were correlated with the voiding trial results using a Chi-squared analysis for sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). A total of 266 subjects were included in the final evaluation. The screening subjective question had a sensitivity of 85.7% (CI 71.46 to 94.57%), a specificity of 91.5% (CI 87.01 to 94.79%), a PPV of 65.4% (CI 54.78 to 74.77%), and an NPV of 97.14% (CI 94.18 to 98.62%) to detect a failed voiding trial. The NPV of the subjective question regarding bladder emptying in the post-operative urogynecological setting is high at >97%, suggesting that it might be reasonable to forgo a formal voiding trial in patients who subjectively feel that they have emptied their bladder.

Nocturia in mothers and enuresis in children: Possible links.

The aim of the present study was to examine the relationship between nocturnal enuresis (NE) of childhood and nocturia of parents. The study was conducted across the network of general pediatricians of the ASL NA 1 of Naples, Italy. All the children with NE and their mothers were invited to attend the clinic for the study. Data were collected by personal interview. A 5-day bladder diary was collected from all the children. The mothers with nocturia were given a 3-day frequency-volume chart to assess the presence of nocturnal polyuria or reduced bladder capacity. Both children and mothers underwent a bladder ultrasound scan to measure the bladder wall thickness. A total of 224 mothers (aged between 23 and 45 years, average 33.3±4.1 years) and their 225 children (aged between 7 and 13 years, average 8.35±1.81 years) were investigated. Of the 224 mothers, 90 (40%) had nocturia, of which 55 (61%) clearly remembered that they had suffered from NE in childhood. Only 4 (11%) out of the 35 women without nocturia had NE (p<0.001). Children with persistence of NE beyond 11 years were more likely to have a parent with nocturia. Children with non-monosymptomatic NE were more likely to have mothers with nocturia (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2-7.1, p<0.01) or overactive bladder symptoms (OR 1.9, 95% CI 1.1-15.2, p<0.01). These data suggest that there is a link between NE in childhood and nocturia in adulthood. A strong relationship was found between overactive bladder in children and overactive bladder in their mothers.

Feasibility of the Lilium α-200 portable ultrasound bladder scanner for accurate bladder volume measurement.

PurposeThe aim of this study was to investigate whether data obtained from the Lilium α-200 (Lilium Otsuka Co., Ltd., Japan) correlated with conventional frequency-volume chart (FVC) and post-void residual urine volume (PVR) obtained by urethral catheterization.Materials and MethodsThis was a prospective multicentre study. Patients hospitalized for the treatment of lower urinary tract symptoms were included. Patients were evaluated with conventional FVC and Lilium α-200 for 2 days. PVR was measured by urethral catherization after urination at the end of the 2 day evaluation period.ResultsA total of 42 patients were enrolled in this study. Voided volume and PVR measured by Lilium α-200 were significantly correlated with voided volume obtained from conventional FVC and PVR measured by urethral catheterization, respectively. There was considerable measurement error in voided volume measured by Lilium α-200 (−21.0±102.0 mL). In contrast, the error between PVR measured by the Lilium α-200 and PVR obtained by urethral catheterization was 2.4±52.0 mL. Additionally, high body mass index, but not sex, benign prostate hyperplasia, time zone of measurement (daytime vs. nighttime), and examiners (a urologist versus other healthcare providers) were significantly associated with inaccurate results in voided volume.ConclusionsVoided volume and PVR measured by the Lilium α-200 were correlated with voided volume obtained from conventional FVC and PVR measured by urethral catheterization, although accuracy of the measurements was not high. The Lilium α-200 is a useful device to easily measure approximate bladder volume.

Incidence, prognosis, and risk factors for bladder and bowel dysfunction due to incidental dural tears in lumbar microendoscopic surgery

BACKGROUND CONTEXTDespite the common occurrence of incidental dural tears, the incidence and prognosis of bladder and bowel dysfunction (BBD) due to incidental dural tears in lumbar spinal surgery are not well known because of the lack of reported cases. PURPOSETo analyze the incidence, prognosis, and risk factors for BBD after lumbar microendoscopic surgery with or without incidental dural tears. STUDY DESIGN/SETTINGA retrospective cohort study. PATIENT SAMPLEWe analyzed 2,421 patients who underwent lumbar microendoscopic surgery and investigated patients with BBD after an incidental durotomy during surgery. OUTCOME MEASURESPatients were divided into three groups on the basis of dysuria and defecation disorders: severe BBD, mild BBD, and no BBD. The post void residual volumes before and after surgery were compared using an ultrasound bladder scanner or bladder catheterization after confirmation of urination. Bowel dysfunction was evaluated by subjective symptomatic deterioration and the increase in the frequency and duration of postoperative medical care. METHODSRisk factors for BBD were analyzed using surgical video documentation to determine the dural tear site and cauda equina exposure from the dural sac. Patients with BBD were prospectively followed up for prognosis determination. The chi-square test was used to compare the incidence of BBD between patients with dural tears and those without. Propensity score-adjusted logistic regression analysis was performed to evaluate the effects of various factors on the incidence of postoperative BBD. RESULTSThe incidence of dural tears was 6.9% (168/2,421). The overall incidence of BBD was 3.0% (73/2,421), while the incidences of BBD (mild+severe BBD) and severe BBD due to incidental dural tears were 1.2% (30/2,421) and 0.8% (20/2,421), respectively. The incidence of BBD in patients with dural tears and those without tears was 17.9% [30/168] and 1.9% [43/2,253; p<.001]), respectively. BBD rates at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery were 64.0%, 44.0%, 40.0%, 28.0%, and 13.6%, respectively. Logistic regression analysis revealed that the male sex (odds ratio [OR], 4.20), dural tears in the central area (OR, 10.15), and exposure of the cauda equina (OR, 51.04) were significant risk factors. CONCLUSIONSThe incidence of dural tears in lumbar microendoscopic surgeries are associated with an increased incidence of BBD. The recovery rate for BBD due to incidental dural tears is generally good; however, some patients experience long-term symptoms. Clinicians should be aware that incidental dural tears with cauda equina exposure can increase the risk of BBD.

Bladder Scans and Postvoid Residual Volume Measurement Improve Diagnostic Accuracy of Cauda Equina Syndrome.

A prospective, observational cohort study. The aim of this study was to determine the role of pre and postvoid bladder scan in predicting cauda equina syndrome (CES). The thesis was that bladder scanning [specifically postvoid residual (PVR) volume] would have higher diagnostic accuracy than physical examination alone. CES is an ill-defined condition with a spectrum of presenting symptoms. There is neither a combination of clinical symptoms and/or signs that reliably predicts cauda equina compression nor single defining clinical criterion that has 100% predictive value to confirm or exclude CES. Patients with suspected CES admitted over a 6-month period at a single institution were prospectively assessed by physical examination (including digital rectal examination and pin prick perianal sensation) and bladder ultrasound scanning (recording pre- and PVR volume). These results were compared with the subsequent magnetic resonance imaging (MRI) scans and those patients who had emergent surgery for CES. Ninety-two patients were included in the study (52 women) with a mean age of 44.9 years.An MRI scan demonstrating causing compression of the cauda equina was present in only 18% (17/92).The sensitivity of anal tone to predict CES was 52.9%. Peri-anal numbness (either unilateral or bilateral) had sensitivity of 82.3% and negative predictive value of 92%.For nonoperated group (without CES), mean PVR was 199 mL (95% confidence interval ± 59 mL). On the basis of receiver operating curves, the optimal bladder volume cut-off for predicting CES was ≥200 mL for PVR volume. A PVR of <200 mL gave CES probability of 3.6%. If >200 mL, then the probability of having CES is 43% (P < 0.000003). A PVR <200 mL had a negative predictive value of 97%. Bladder scanning was a useful adjunct in the diagnosis of CES. It had a better negative predictive value than physical examination. 3.

Feasibility of approximate measurement of bladder volume in male patients using the Lilium α-200 portable ultrasound bladder scanner.

This study examined the accuracy of a new portable ultrasound bladder scanner, the Lilium α-200 (Lilium Otsuka, Kanagawa, Japan), by evaluating the correlation between bladder volumes periodically measured by the Lilium α-200 and instilled volume during video-urodynamic studies (V-UDS). Using the Lilium α-200, fluid volume was measured prospectively in the bladders of patients with lower urinary tract dysfunction during V-UDS. This was done both immediately after micturition (for assessment of post-void residual [PVR] volume) and at 1-minute intervals during filling cystometry with patients in the supine position. These measurements were then compared with the PVR volume obtained directly by catheter drainage and instilled volume during cystometry using paired t tests and Spearman's rank correlation. Fifteen male patients (median age 70.5 years; range 18-84 years) were included in the study. The PVR volume measured by the Lilium α-200 was strongly correlated with that obtained by catheter drainage (r = 0.94; P < 0.0001). There was a strong correlation between instilled and bladder volumes measured by the Lilium α-200 at every minute during and at the end of instillation (281 measurements in 15 patients; r = 0.86; P < 0.0001). However, the relative error of bladder volumes measured by the Lilium α-200 during cystometry showed considerable variation (mean [± SD] 5.6 ± 62.9%). Bladder volumes measured periodically by the Lilium α-200 during cystometry were strongly correlated with actual PVR or instilled volumes. However, they showed considerable variation and may not predict actual volume accurately. The Lilium α-200 is feasible for obtaining an approximate measure of bladder volume.