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Gammie A, Wachter SD. Research priorities for diagnostic instrumentation in urinary incontinence. Proc Inst Mech Eng H 2024; 238:682-687. [PMID: 37667889 DOI: 10.1177/09544119231193884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
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.
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Andreev VP, Helmuth ME, Smith AR, Zisman A, Cameron AP, DeLancey JOL, Bushman WA. Dynamic analysis of the individual patterns of intakes, voids, and bladder sensations reported in bladder diaries collected in the LURN study. PLoS One 2023; 18:e0284544. [PMID: 37983243 PMCID: PMC10659201 DOI: 10.1371/journal.pone.0284544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
The goal of this study was to develop the novel analytical approach and to perform an in-depth dynamic analysis of individual bladder diaries to inform which behavioral modifications would best reduce lower urinary tract symptoms, such as frequency and urgency. Three-day bladder diaries containing data on timing, volumes, and types of fluid intake, as well as timing, volumes, and bladder sensation at voids were analyzed for 197 participants with lower urinary tract symptoms. A novel dynamic analytic approach to bladder diary time series data was proposed and developed, including intra-subject correlations between time-varying variables: rates of intake, bladder filling rate, and urge growth rate. Grey-box models of bladder filling rate and multivariable linear regression models of urge growth rate were developed for individual diaries. These models revealed that bladder filling rate, rather than urine volume, was the primary determinant of urinary frequency and urgency growth rate in the majority of participants. Simulations performed with the developed models predicted that the most beneficial behavioral modifications to reduce the number of urgency episodes are those that smooth profiles of bladder filling rate, which might include behaviors such as exclusion of caffeine and alcohol and/or other measures, e.g., increasing number and decreasing volumes of intakes.
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Affiliation(s)
- Victor P. Andreev
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Margaret E. Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Abigail R. Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Anna Zisman
- Section of Nephrology, University of Chicago, Chicago, IL, United States of America
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America
| | - John O. L. DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Wade A. Bushman
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States of America
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Ghatas MP, Burkett LS, Grob G, Daniels PT, Stothers L, Query HE, Shields MK, Speich JE, Klausner AP. A stepwise approach for functional near infrared spectroscopy measurement during natural bladder filling. Transl Androl Urol 2023; 12:1477-1486. [PMID: 37969775 PMCID: PMC10643392 DOI: 10.21037/tau-23-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Functional near infrared spectroscopy (fNIRS) is a versatile, noninvasive, and inexpensive tool that can be used to measure oxyhemoglobin (O2Hb) changes in the cortical brain caused by increasing bladder sensation during filling in upright posture. This study's purpose is to provide a rigorous methodologic template that can be implemented for comparative studies of fNIRS in the diagnosis and management of lower urinary tract symptoms including overactive bladder (OAB) and other forms of lower urinary tract dysfunction. Methods Participants without any urologic conditions completed a validated oral hydration protocol facilitating and equilibrating natural bladder filling. First desire to void and real time bladder sensation (0-100%) were recorded using a Sensation Meter. A 24-channel fNIRS template simultaneously recorded prefrontal cortical O2Hb. Each channel was analyzed between "first desire" to void and 100% sensation, defined in this study as the period of "high sensation". Channels were sub-divided by cortical regions: right (nine channels), left (nine channels), middle (six channels). Results A total of eight participants (male: n=4, female: n=4) were enrolled with mean age 39±19.9 years and body mass index (BMI) of 25±3.93 kg/m2. There were no differences in age, BMI, race, or OAB survey scores based on biological sex. Signal acquisition improved with power bank use, postural head support for motion reduction, and head cap optimization. Acceleration-based concurrent motion measurement was effectively utilized to remove motion artifacts. O2Hb concentration patterns appeared irregular during low sensation and increased during high sensation after first desire across the frontal cortex. Conclusions Employing a stepwise approach, this study defined a methodological guide for improved prefrontal fNIRS signal acquisition and analysis during bladder filling. The technique demonstrated that prefrontal fNIRS cortical O2Hb increases with elevated bladder sensation in normal subjects and sets the stage for comparative studies in individuals with OAB and other forms of lower urinary tract dysfunction.
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Affiliation(s)
- Mina P. Ghatas
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Linda S. Burkett
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gabrielle Grob
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Peter T. Daniels
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lynn Stothers
- Department of Urology and Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Helen E. Query
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael K. Shields
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - John E. Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P. Klausner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Andreev VP, Helmuth ME, Smith AR, Zisman A, Cameron AP, DeLancey JOL, Bushman WA. Dynamic analysis of the individual patterns of intakes, voids, and bladder sensations reported in bladder diaries collected in the LURN study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.05.23288100. [PMID: 37066258 PMCID: PMC10104230 DOI: 10.1101/2023.04.05.23288100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
The goal of this study was to perform an in-depth dynamic analysis of individual bladder diaries to inform which behavioral modifications would best reduce lower urinary tract symptoms, such as frequency and urgency. Three-day bladder diaries containing data on timing, volumes, and types of fluid intake, as well as timing, volumes, and bladder sensation at voids were analyzed for 197 participants with lower urinary tract symptoms. A novel dynamic analytic approach to bladder diary time series data was proposed and developed, including intra-subject correlations between time-varying variables: rates of intake, bladder filling rate, and urge growth rate. Grey-box models of bladder filling rate and multivariable linear regression models of urge growth rate were developed for individual diaries. These models revealed that bladder filling rate, rather than urine volume, was the primary determinant of urinary frequency and urgency growth rate in the majority of participants. Simulations performed with the developed models predicted that the most beneficial behavioral modifications to reduce the number of urgency episodes are those that smooth profiles of bladder filling rate, which might include behaviors such as exclusion of caffeine and alcohol and/or other measures, e.g., increasing number and decreasing volumes of intakes.
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Affiliation(s)
| | | | | | - Anna Zisman
- Section of Nephrology, University of Chicago, Chicago IL, US
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor MI, US
| | - John O. L. DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI, US
| | - Wade A. Bushman
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison WI, US
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Maddra KM, Li R, Nagle AS, Klausner AP, Speich JE. Repeatability of Ultrasound-Defined Bladder Shape Metrics in Healthy Volunteers. Res Rep Urol 2022; 14:185-192. [PMID: 35572816 PMCID: PMC9091689 DOI: 10.2147/rru.s351347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Kaitlyn M Maddra
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Rui Li
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
- Correspondence: John E Speich, Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA, Tel +1 804 827 7036, Fax +1 804 827 7030, Email
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Kolli H, Nagle AS, Sheen D, Naimi HA, Vinod NN, Cullingsworth ZE, Li R, Klausner AP, Speich JE. Influence of visual and auditory cues about bladder volume on real-time filling sensation in healthy volunteers. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2022; 10:44-51. [PMID: 35291416 PMCID: PMC8918395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Auditory/visual (A/V) cues can trigger urgency in some individuals with overactive bladder (OAB), and patient-reported bladder sensation can be characterized during non-invasive oral hydration studies. The aim of this investigation was to test the hypothesis that A/V cues of bladder volume can alter patient-perceived bladder sensation during hydration studies. Healthy volunteers without urinary symptoms based on ICIq-OAB survey scores were recruited for an oral hydration study where they completed two fill/void cycles. The study was repeated twice, one week apart. Throughout bladder filling, participants reported real-time sensation (0-100%) using a Sensation Meter, and bladder volumes were measured at 5 min intervals with both 3D ultrasound and BladderScan®. Participants were divided into a Cues(+) group that was allowed to view their ultrasound images and hear volume measurements of the BladderScan® every 5 min and a Cues(-) group that was not exposed to these A/V cues. The A/V Cues(+) group had 10 participants (5 women and 5 men) and the Cues(-) group had 10 participants (7 women and 3 men). During the second visit, the Cues(+) group demonstrated decreased sensation compared to the Cues(-) group in the slower first fill, but not the faster second fill. The results of this study demonstrate that A/V cues about bladder volume can acutely alter sensation during hydration studies in healthy individuals with normal bladder function.
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Affiliation(s)
- Hiren Kolli
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA 23298, USA
| | - Anna S Nagle
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA 23284, USA
| | - Derek Sheen
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA 23298, USA
| | - Hameeda A Naimi
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA 23298, USA
| | - Naomi N Vinod
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA 23298, USA
| | - Zachary E Cullingsworth
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA 23284, USA
| | - Rui Li
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA 23284, USA
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA 23298, USA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA 23284, USA
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Li R, Nagle AS, Maddra KM, Vinod N, Prince SA, Tensen SI, Thapa D, Sebastian B, Sethi D, Alattar A, Carucci LR, Klausner AP, Speich JE. Irregular bladder shapes identified in women with overactive bladder: an ultrasound nomogram. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:367-377. [PMID: 34796252 PMCID: PMC8595087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
In this study, an ultrasound-based bladder shape nomogram was developed using data from women without overactive bladder (OAB) and tested in women with OAB to identify irregular bladder shapes. The goal was development of a nomogram that can ultimately be used for non-invasive identification of a bladder shape-associated OAB phenotype. Transabdominal 3-dimensional (3D) bladder ultrasound images were collected at 1-minute intervals during urodynamics studies and at 5-10-minute intervals during oral hydration studies. These prospective studies enrolled women with and without OAB based on International Consultation on Incontinence questionnaire on OAB (ICIq-OAB) question 5a (OAB 5a≥2, without OAB 5a<2). Bladder perimeters were manually traced and refined using GE 4D-View software. Nomograms for the transverse, sagittal and coronal perimeter-volume relationships were developed for women without OAB. A power model was used to approximate upper and lower nomogram bounds with 95% confidence intervals. Nomograms were tested using data from women with OAB, and each participant was classified as having an irregular bladder shape based on the number of perimeter values outside the nomogram bounds. Nomograms were developed using 533 images from 27 women without OAB (14 from urodynamics and 13 from hydration studies) and were tested using 264 images from 24 women with OAB (16 urodynamics and 8 hydration). The sagittal perimeter nomogram provided the best results, with irregular sagittal perimeters identified in 6/24 (25%) women with OAB and 0/27 (0%) without OAB. An irregular sagittal perimeter was significantly associated with OAB (P<0.05). Ultrasound-based nomograms may enable feasible, non-invasive identification of a subgroup of women with bladder shape-associated OAB.
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Affiliation(s)
- Rui Li
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
| | - Kaitlyn M Maddra
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Naomi Vinod
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Suzanne A Prince
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
| | - Sarah I Tensen
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
| | - Devina Thapa
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Blessan Sebastian
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Dhruv Sethi
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Abraham Alattar
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
| | - Laura R Carucci
- Department of Radiology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - Adam P Klausner
- Department of Surgery, Division of Urology, Virginia Commonwealth University School of MedicineRichmond 23298, VA, USA
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond 23284, VA, USA
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Nagle AS, Cullingsworth ZE, Li R, Carucci LR, Klausner AP, Speich JE. Bladder wall micromotion measured by non-invasive ultrasound: initial results in women with and without overactive bladder. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:44-52. [PMID: 33816693 PMCID: PMC8012835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Rhythmic contractions of the bladder wall during filling result from the synchronization of bladder wall micromotion and are often observed in the urodynamic tracings of individuals with urinary overactive bladder (OAB). This study's objective was to develop a novel, non-invasive method to measure bladder wall micromotion and to conduct an initial study to test the hypothesis that elevated micromotion is associated with OAB. METHODS This prospective study enrolled women with OAB and asymptomatic volunteers as measured by the ICIQ-OAB survey. After filling the bladder to 40% cystometric capacity, 85 second cine-loops were obtained using a GE Voluson E8 ultrasound system with an 8 MHz curved, abdominal probe. A custom correlation-based texture tracking MATLAB algorithm was used to measure changes in the bladder wall thickness over time and correlate with changes in vesical pressure. Significant bladder wall micromotion was defined as changes in wall thickness with amplitudes higher than 0.1 mm in the frequency range of 1.75-6 cycles/minute as calculated from Fast Fourier Transform (FFT) analysis. The micromotion algorithm was tested on 30 women including 17 with OAB and 13 asymptomatic volunteers. RESULTS Micromotion was identified in 41% of subjects with OAB and 0% of asymptomatic volunteers, indicating a significant association of micromotion with OAB (Fisher's exact test, P=0.010). Micromotion was also found to have a significant association with a clinical diagnosis of detrusor overactivity (Fisher's exact test, P=0.031). Frequencies with elevated micromotion correlated with frequencies of vesical pressure fluctuations. CONCLUSIONS The feasibility of a non-invasive method to measure bladder wall micromotion was demonstrated using transabdominal anatomical motion mode (M-mode) ultrasound. Presence of micromotion was significantly associated with OAB and with urodynamic-identified rhythm.
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Affiliation(s)
- Anna S Nagle
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Zachary E Cullingsworth
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Rui Li
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Laura R Carucci
- Department of Radiology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
- Department of Surgery/Division of Urology Hunter Holmes McGuire Veterans Affairs Medical CenterRichmond, VA, USA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
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Sebastian B, Swavely NR, Sethi D, Nagle AS, Thapa D, Vinod NN, Cullingsworth ZE, Balthazar AK, Klausner AP, Speich JE. Comparison of Sensation Event Descriptors in Participants with Overactive and Normal Bladders during Non-Invasive Hydration Studies. ARCHIVES OF NEPHROLOGY & UROLOGY STUDIES 2021; 1:03. [PMID: 35037002 PMCID: PMC8758112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Despite the importance of alterations in bladder sensation, objective metrics to characterize sensation outside of urodynamics remain limited. A real-time sensation meter enables recording of sensation event descriptors throughout filling. The purpose of this study was to evaluate the differences in sensation event descriptor patterns between normal participants and those with OAB. METHODS Normal and OAB participants were enrolled from responses to the ICIq-OAB survey question on urgency (Q5a: 0 vs. ≥ 3). Real-time bladder sensation on a 0%-100% scale was recorded on a validated tablet sensation meter throughout two fill-void cycles. The first and second fills were considered "slow" and "fast" respectively. After each sensation meter change (sensation event), a pop-up screen asked participants to characterize sensation with one or more of these descriptors: "tense," "pressure," "tingling," "painful," and/or "other." Oral hydration was achieved by rapid consumption of 2L G2® Gatorade. RESULTS Data from 29 participants (12 normal/17 OAB) were analyzed. The rate of filling from bladder volume and fill duration, was greater for the fast fill in both groups. In the slow fill, "tingling" (64 ± 3% OAB vs. 77 ± 3% normal, p=0.008) and "tense" (78 ± 3% OAB vs. 94 ± 1% normal, p<0.001) occurred at lower sensations in OAB participants. CONCLUSION During only the slow fill, OAB individuals experience the sensation descriptors of "tingling" and "tense" at earlier sensations than normal individuals. Therefore, this non-invasive method to evaluate real-time sensation descriptors during filling may identify important sensation patterns and improve understanding and phenotyping of OAB.
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Affiliation(s)
- Blessan Sebastian
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Natalie R. Swavely
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dhruv Sethi
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Anna S. Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
| | - Devina Thapa
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Naomi N. Vinod
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Zachary E. Cullingsworth
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
| | - Andrea K. Balthazar
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA,Corresponding Author: Adam P. Klausner, Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA,
| | - John E. Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA, USA
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McCloskey KD, Wyndaele JJ, Speich JE, Birder L, Nelson PP. Should we be revisiting LUT basic science and clinical measurement of LUT sensation to improve patient care? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S23-S29. [PMID: 32662560 DOI: 10.1002/nau.24273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/27/2019] [Indexed: 11/10/2022]
Abstract
AIMS This article reviews current knowledge of the underpinning mechanisms of how the bladder senses fullness locally and also revisits clinical measurements of lower urinary tract sensation. The former represents cellular sensing during bladder filling whereas the latter describes the sensations leading to conscious perception of bladder fullness. METHODS The topic was discussed in a "think tank" session at the 2019 International Consultation on Incontinence-Research Symposium in Bristol, UK; summarized in the present review. RESULTS Recent advances in the basic science of bladder sensing relating to (a) the bladder wall-urothelial cells, sensory nerves, interstitial cells, and smooth muscle cells and (b) putative chemo/mechanosensors in the urethra-paraneurons or "brush cells" are discussed. Validated clinical measurement of lower urinary tract sensation is reviewed in the context of how this could be better harnessed for patient benefit. We discuss the potential of app/tablet/mobile technology based on triggers and distractors to override aberrant local sensing/higher sensation and how these technologies could be utilized in treatment. CONCLUSIONS We conclude that a better understanding of bladder sensation is essential to inform clinical management of lower urinary tract symptoms.
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Affiliation(s)
- Karen D McCloskey
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - John E Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Birder
- Departments of Medicine-Renal Electrolyte Division and Pharmacology/Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pierre P Nelson
- Department of Physical Medicine and Rehabilitation, Hôpital Rothschild, Sorbonne Université, Paris, France
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Abstract
Urodynamics is the study of the storage and evacuation of urine from the urinary tract. The aim is to reproduce the patient’s symptoms and provide a pathophysiological explanation for them by identifying all factors that contribute to the lower urinary tract dysfunction, including those that are asymptomatic. Urodynamics consists of various tests, each of which is designed to assess a different aspect of lower urinary tract function. There is a lack of evidence regarding when urodynamics should be used in the non-neurogenic bladder. Some small randomised controlled trials suggest that urodynamics does not alter the outcome of surgery for stress urinary incontinence when compared with office evaluation alone. However, this is widely felt to be inaccurate and many health-care professionals still advocate the use of urodynamics prior to any invasive treatment, especially surgery on the lower urinary tract. There have been few technological advances in urodynamics in recent years. Air-charged rather than fluid-filled catheters were thought to help reduce artefact, but the evidence is unclear, and there is doubt over their accuracy. Ambulatory urodynamics is carried out over a longer period of time, enabling physiological bladder filling, but it remains invasive and artificial. To attempt to replicate symptoms more accurately, there have been efforts to develop wireless devices to measure detrusor pressure directly. These may be promising but are far from suitable in humans at present. Urodynamics continues to provide useful information for assessing lower urinary tract function, but further large studies are required to assess its value and develop innovations to improve the accuracy of the tests and acceptability to patients.
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Affiliation(s)
- Georgina Baines
- Department of Urogynaecology, King's College Hospital, London, UK
| | | | - George Araklitis
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Gammie A, Speich JE, Damaser MS, Gajewski JB, Abrams P, Rosier PFWM, Arlandis S, Tarcan T, Finazzi Agrò E. What developments are needed to achieve less-invasive urodynamics? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S36-S42. [PMID: 32022941 DOI: 10.1002/nau.24300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 11/07/2022]
Abstract
AIMS To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. METHODS A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. RESULTS There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. CONCLUSIONS Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Margot S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Vinod NN, Nagle AS, Naimi HA, Kolli H, Sheen D, Nandanan N, Carucci LR, Speich JE, Klausner AP. Bladder volume correction factors measured with 3D ultrasound and BladderScan. THE CANADIAN JOURNAL OF UROLOGY 2019; 26:9829-9834. [PMID: 31469637 PMCID: PMC6983921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The aim of this study was to investigate conventional 3D ultrasound and portable BladderScan volume measurements and implement correction factors to ensure accurate volume metrics. MATERIALS AND METHODS Healthy participants without urinary urgency were recruited for a prospective hydration study in which three consecutive voids were analyzed for two separate visits. Just before and after voiding, 3D ultrasound and BladderScan volumes were measured. Estimated voided volumes were calculated as the volume immediately prior to void minus any post void residual and were compared to actual voided volumes measured using a graduated container. Percent errors were calculated, and an algebraic method was implemented to create correction factors for 3D ultrasound and BladderScan. RESULTS Sixteen individuals completed the study, and six voids were recorded for each participant. A total of 96 volume measurements ranging from 0 mL to 1050 mL with an average of 394 +/- 26 mL were analyzed. Both 3D ultrasound and BladderScan significantly underestimated voided volumes with averages of 296 +/- 22 and 362 +/- 27, respectively. Average percent error for the 3D ultrasound group was 30.1% (pre-correction) and 20.7% (post-correction) (p < 0.01) and 22.4% (pre-correction) and 21.8% (post-correction) for the BladderScan group (p = 0.20). The voided volume correction factors for 3D ultrasound and BladderScan were 1.30 and 1.06, respectively. CONCLUSION BladderScan and 3D ultrasound typically underestimate voided volumes. Correction factors enabled more accurate measurements of voided volumes for both 3D ultrasound and BladderScan. Accurate volume measurements will be valuable for the development of non-invasive urodynamics techniques.
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Affiliation(s)
- Naomi N Vinod
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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14
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Sheen D, Kolli H, Nagle AS, Cullingsworth Z, Vinod NN, Naimi HA, De Wachter SG, Mazzeo SE, Stothers L, Speich JE, Klausner AP. Validation of a real-time bladder sensation meter during oral hydration in healthy adults: Repeatability and effects of fill rate and ultrasound probe pressure. Low Urin Tract Symptoms 2019; 11:224-231. [PMID: 31298501 DOI: 10.1111/luts.12275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A non-invasive protocol was previously developed using three-dimensional ultrasound and a sensation meter to characterize real-time bladder sensation. This study the protocol by measuring the effects of fill rateand ultrasound probe pressure during oral hydration. METHODS Healthy volunteers with no urinary symptoms (based on International Consultation on Incontinence Questionnaire on Overactive Bladder surveys) were recruited into an oral hydration study. Throughout two complete fill-void cycles, participants drank 2 L Gatorade G2 (The Gatorade Company, Inc., Chicago, Illinois) and used a touch-screen sensation meter to record real-time bladder sensation (0%-100%). The study was repeated three times, once per week (Visits A, B, and C). In Visits A and B, ultrasound was used to measure bladder volume every 5 minutes. Ultrasound was not used in Visit C except at 100% capacity. Volume data from Visit B were used to estimate volumes throughout the fills in Visit C. Sensation-capacity curves were generated for each fill for comparative analysis. RESULTS Ten participants completed three visits (60 total fills). Increased fill rate led to decreased sensation throughout filling, andultrasound probe pressure led to increased sensation. Participants reported higher sensation at low volumes during Fill 1 of Visit A before training with the sensation meter. Sensation curves with intermittent ultrasound showed repeatability for Fill 2 in Visits A and B. Fill rate and ultrasound probe pressure affect real-time bladder sensation during oral hydration. CONCLUSIONS This study demonstrated repeatability of real-time bladder sensation during a two-fill oral hydration protocol with ultrasound.
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Affiliation(s)
- Derek Sheen
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hiren Kolli
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Zachary Cullingsworth
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Naomi N Vinod
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hameeda A Naimi
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Stefan G De Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium.,Department of Urology, University of Antwerpen, Wilrijk, Belgium
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, College of Humanities and Sciences, Richmond, Virginia
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Swavely NR, Speich JE, Stothers L, Klausner AP. New Diagnostics for Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2019; 14:90-97. [PMID: 31938079 PMCID: PMC6959483 DOI: 10.1007/s11884-019-00511-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) is a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition. RECENT FINDINGS New techniques in evaluating the voiding phase include penile cuff test, external pressure sensing condom catheter, ultrasound measurement of detrusor wall thickness, ultrasound measurement of intravesical prostatic protrusion, doppler ultrasound and NIRS technology. Evaluation of the filling phase is still undergoing much development and requires additional validation studies. The techniques undergoing evaluation include sensation meters during UDS, assessing bladder micromotion and wall rhythm, assessing detrusor wall biomechanics, ultrasound measurement of detrusor wall thickness, pelvic doppler ultrasound, as well as functional brain imaging including fNIRS and fMRI. SUMMARY The development of novel, non-invasive, diagnostic tools have the potential for better evaluation of LUTS with earlier and enhanced treatments. This will likely improve the quality of life for men with LUTS.
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Affiliation(s)
- Natalie R Swavely
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
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