Determination of postvoid residual by translabial ultrasound

A Pre-Voiding Alarm System Using Wearable Ultrasound and Machine Learning Algorithms for Children With Nocturnal Enuresis

Nocturnal enuresis is a bothersome condition that affects many children and their caregivers. Post-voiding systems is of little value in training a child into a correct voiding routing while existing pre-voiding systems suffer from several practical limitations, such as cumbersome hardware, assuming individual bladder shapes being universal, and being sensitive to sensor placement error. Methods: A low-voltage ultrasound system with machine learning has been developed in estimating bladder filling status. A custom-made flexible 1D transducer array has been excited by low-voltage coded pulses with a pulse compression technique for an enhanced signal-to-noise ratio. In order to minimize the negative influence of possible transducer misplacement, a multiple-position training strategy using machine learning has been adopted in this work. Three popular classification methods, KNN, SVM and sparse coding, have been utilized to classify the acquired different volumes ranging from 100 ml to 300 ml into two categories: low volume and high volume. The low-volume category requires no further action while the high-volume category triggers an alarm to alert the child and caregiver. Results: When the sensor placement is ideal, i.e., the position of the practical sensor placement is on spot with the trained position, the precision and recall of the classification using sparse coding are [Formula: see text] and [Formula: see text], respectively. Even if the transducer array is misplaced by up to 4.5 mm away from the ideal location, the proposed system is able to maintain high classification accuracy (precision [Formula: see text] and recall [Formula: see text]). Category: Early/Pre-Clinical Research Clinical and Translational Impact: The proposed ultrasound sensor system for nocturnal enuresis is of significant clinical and translational value as it addresses two major issues that limit the wide adoption of similar devices. Firstly, it offers enhanced safety as the entire system has been implemented in the lowvoltage domain. Secondly, the system features ample tolerance to sensor misplacement while maintaining high classification accuracy. These features combined provide a much more user-friendly environment for children and their caregivers than existing devices.

An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders

AIMS

The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus.

METHODS

This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus.

RESULTS

A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible.

CONCLUSION

A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.

Twisting of transobturator midurethral slings: does it matter?

INTRODUCTION AND HYPOTHESIS

We assessed rotation/twisting of transobturator midurethral slings (TOTs) and tested for associations with de novo chronic pain and voiding dysfunction.

METHODS

A retrospective pilot study including patients seen after Monarc™ TOT surgery at a single tertiary hospital in 2005-2016. Patients underwent an interview, clinical examination, uroflowmetry and 4D pelvic floor ultrasound. Volume datasets were analyzed blinded against all other data. Sling rotation/twisting was evaluated in volumes obtained at rest. The sling axis was measured relative to the vertical in the midline and in the most lateral parasagittal slice. Total sling rotation was calculated by summation of absolute angle differences between midline and lateral angles. "Corkscrew" rotation was noted when direction of rotation was opposite on the contra-lateral side.

RESULTS

The study included 215 patients. Fifty-two (24%) were excluded, leaving 163. Mean age was 57 years (28-87; SD 12), mean BMI 29.4 kg/m² (18.3-47.4, SD 6). Follow-up was at a median of 17 months (IQR 11-27). Chronic de novo pain was reported by 15 women (9%; dyspareunia by 11 and pelvic/vaginal pain by 4). On imaging, mean total sling rotation was 144° (12-335, SD 56). In the majority (n = 103, 63%) it rotated counter-clockwise from its midline position and in 30 (18%) it rotated clockwise. "Corkscrew" rotation was noted in 30 (18%). De novo chronic pain was associated with lower BMI and vaginal sling exposure but not with sling rotation. The latter was not found to be associated with voiding dysfunction either.

CONCLUSIONS

Monarc™ TOTs rotate considerably throughout their course. The degree of twisting or rotation and its direction was not found to be associated with de novo postoperative chronic pain or voiding dysfunction.

Can we replace the catheter when evaluating urinary residuals?

AIMS

To test the different formulae to calculate the bladder volume using ultrasound; the accuracy of patients hearing/feeling "bubbles" at the end of urodynamics testing as a measure of being empty; and how good we are at estimating PVR using X-ray at the end of video urodynamics testing.

METHODS

This was a prospective cohort study. Using Sonosite 180 plus, bladder volumes were calculated as, height × width × depth × proportionality constant (0.52, 0.625, 0.65, and 0.7) Patients were asked whether the patient heard or felt "bubbles" at the end of the investigation. Each patient was fluoroscopically screened and the clinician estimated the volume and compared with single-use catheter volume.

RESULTS

A total of 85 patients were assessed. All four formulae were significantly correlated. The PC, 0.52, correlated best (r = 0.938, P < 0.001) with no significant difference with the actual volumes ( P = 0.275). The "bubbles test" had a positive predictive value of 93%. A video postvoid residual (PVR) estimation significantly correlated with catheterised bladder volume ( r = 0.842, P < 0.001). There was no significant difference between the estimated and actual bladder volumes ( P = 0.579).

CONCLUSION

This study showed that although all four formulae correlated significantly, the PC of 0.52 was the only formula without a significant difference from the actual volume. More work is needed to produce patient individualised PC. Our clinicians were able to accurately estimate the PVR on X-ray. This study has identified the best formula to accurately estimate bladder volume and that video estimation along with the "bubbles" test can avoid unnecessary intervention.

An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)

INTRODUCTION

The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report.

METHODS

This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus).

RESULTS

A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible.

CONCLUSION

A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.

An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP)

INTRODUCTION

The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report.

METHODS

This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus).

RESULTS

A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible.

CONCLUSION

A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

OBJECTIVES

To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP).

METHODS

This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered.

RESULTS

One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877).

CONCLUSIONS

Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Pelvic ultrasound evaluation for benign prostatic hyperplasia: prediction of obstruction

Global improvements in water quality, management of infectious diseases, and other medical therapeutics have resulted in a growing population of healthy aging men. One obligate anatomic consequence of aging for these men is the development of benign prostatic hyperplasia (BPH) with secondary bladder outlet obstruction. Although the voiding symptoms associated with the change in bladder health over time predominantly impact the quality of a man's daily experience, there are also significant medical consequences of BPH that require intervention. It is a challenge to distinguish men who are at risk for these medical consequences from the much larger population of older men with voiding symptoms (lower urinary tract symptoms, LUTS). A variety of national guidelines have been developed to establish a diagnostic paradigm for meeting this challenge, but all suffer from inadequate sensitivity for the early identification of men at risk for permanent bladder injury. It is likely that the application of a thorough pelvic ultrasound designed to identify the pertinent anatomic aspects of both the bladder and prostate will improve the sensitivity of these diagnostic paradigms, with subsequent improvement in the outcomes for men with BPH/LUTS.