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Gonzalez-Pereira JP, Johnson CJ, Wells S, Bushman W, Roldan-Alzate A. Technical feasibility of uro-dynamic MRI study of voiding biomechanics: a pilot study. Int Urol Nephrol 2024; 56:893-899. [PMID: 37823972 DOI: 10.1007/s11255-023-03823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Dynamic volumetric MRI was used to non-invasively assess voiding biomechanics in a healthy male volunteer. METHODS Using 3D Differential Subsampling with Cartesian Ordering (DISCO) Flex acquisition sequence, volumetric bladder images were obtained throughout the voiding effort. These were subsequently segmented using MIMICS. Segmented anatomical volumes were used to quantify total voided volume, post-void residual, volumetric displacement of urine over time, bladder neck angle, sphericity index, and prostatic urethral angle through the voiding effort. RESULTS Bladder sphericity index correlated positively with flow rate. The greatest degree of bladder neck funneling correlated with the maximum urine flow rate. There was straightening of the prostatic urethral angle during voiding that also correlated positively with urine flow. CONCLUSION This pilot study confirms the potential of dynamic MRI to provide non-invasive assessment of lower urinary tract anatomy and biomechanics during voiding.
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Affiliation(s)
| | - Cody John Johnson
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Shane Wells
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Wade Bushman
- Department of Urology, University of Wisconsin-Madison, Madison, USA
| | - Alejandro Roldan-Alzate
- Department of Mechanical Engineering, Department of Radiology, Department of Biomedical Engineering and Department of Urology, University of Wisconsin-Madison, Madison, USA.
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2
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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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3
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Hennig G, Saxena P, Broemer E, Herrera GM, Roccabianca S, Tykocki NR. Quantifying whole bladder biomechanics using the novel pentaplanar reflected image macroscopy system. Biomech Model Mechanobiol 2023; 22:1685-1695. [PMID: 37249760 PMCID: PMC10511590 DOI: 10.1007/s10237-023-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
Optimal bladder compliance is essential to urinary bladder storage and voiding functions. Calculated as the change in filling volume per change in pressure, bladder compliance is used clinically to characterize changes in bladder wall biomechanical properties that associate with lower urinary tract dysfunction. But because this method calculates compliance without regard to wall structure or wall volume, it gives little insight into the mechanical properties of the bladder wall during filling. Thus, we developed Pentaplanar Reflected Image Macroscopy (PRIM): a novel ex vivo imaging method to accurately calculate bladder wall stress and stretch in real time during bladder filling. The PRIM system simultaneously records intravesical pressure, infused volume, and an image of the bladder in five distinct visual planes. Wall thickness and volume were then measured and used to calculate stress and stretch during filling. As predicted, wall stress was nonlinear; only when intravesical pressure exceeded ~ 15 mmHg did bladder wall stress rapidly increase with respect to stretch. This method of calculating compliance as stress vs stretch also showed that the mechanical properties of the bladder wall remain similar in bladders of varying capacity. This study demonstrates how wall tension, stress and stretch can be measured, quantified, and used to accurately define bladder wall biomechanics in terms of actual material properties and not pressure/volume changes. This method is especially useful for determining how changes in bladder biomechanics are altered in pathologies where profound bladder wall remodeling occurs, such as diabetes and spinal cord injury.
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Affiliation(s)
- Grant Hennig
- Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA
| | - Pragya Saxena
- Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI, 48824, USA
| | - Eli Broemer
- Department of Mechanical Engineering, Michigan State University College of Engineering, East Lansing, MI, 48824, USA
| | - Gerald M Herrera
- Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University College of Engineering, East Lansing, MI, 48824, USA
| | - Nathan R Tykocki
- Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI, 48824, USA.
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4
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Gammie A, Wachter SD. Research priorities for diagnostic instrumentation in urinary incontinence. Proc Inst Mech Eng H 2023:9544119231193884. [PMID: 37667889 DOI: 10.1177/09544119231193884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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5
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Tuttle T, McClintock D, Roccabianca S. Effects of swelling and anatomical location on the viscoelastic behavior of the porcine urinary bladder wall. J Mech Behav Biomed Mater 2023; 143:105926. [PMID: 37269604 DOI: 10.1016/j.jmbbm.2023.105926] [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] [Received: 12/20/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
The ability of the urinary bladder to perform its physiological function depends largely on its mechanical characteristics. Understanding the mechanics of this tissue is crucial to the development of accurate models of not just this specific organ, but of the pelvic floor overall. In this study, we tested porcine bladder to identify variations in the tissue's viscoelastic characteristics associated with anatomical locations and swelling. We investigated this relationship using a series of stress-relaxation experiments as well as a modified Maxwell-Wiechert model to aid in the interpretation of the experimental data. Our results highlight that tissue located near the neck of the bladder presents significantly different viscoelastic characteristics than the body of the organ. This supports what was previously observed and is a valuable contribution to the understanding of the location-specific properties of the bladder. We also tested the effect of swelling, revealing that the bladder's viscoelastic behavior is mostly independent of solution osmolarity in hypoosmotic solutions, but the use of a hyperosmotic solution can significantly affect its behavior. This is significant, since several urinary tract pathologies can lead to chronic inflammation and disrupt the urothelial barrier causing increased urothelial permeability, thus subjecting the bladder wall to non-physiologic osmotic challenge.
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Affiliation(s)
- Tyler Tuttle
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Dillon McClintock
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA.
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6
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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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7
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Abe-Takahashi Y, Kitta T, Ouchi M, Chiba H, Higuchi M, Togo M, Shinohara N. Evaluation of pelvic floor muscle elasticity in patients with overactive bladder syndrome using real-time tissue elastography. Eur J Obstet Gynecol Reprod Biol 2022; 276:9-13. [DOI: 10.1016/j.ejogrb.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/12/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
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8
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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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Chansoria P, Etter EL, Nguyen J. Regenerating dynamic organs using biomimetic patches. Trends Biotechnol 2022; 40:338-353. [PMID: 34412924 PMCID: PMC8831394 DOI: 10.1016/j.tibtech.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
The regeneration of dynamic organs remains challenging because they are intrinsically anisotropic and undergo large volumetric deformation during normal or pathological function. This hampers the durability and applicability of regenerative medicine approaches. To address the challenges of organ dynamics, a new class of patches have emerged with anisotropic and auxetic properties that mimic native tissue biomechanics and accommodate volumetric deformation. Here, we outline the critical design, materials, and processing considerations for achieving optimal patch biomechanics according to target pathology and summarize recent advances in biomimetic patches for dynamic organ regeneration. Furthermore, we discuss the challenges and opportunities which, if overcome, would open up new applications in organ regeneration and expedite the clinical translation of patch-based therapeutics.
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Affiliation(s)
| | | | - Juliane Nguyen
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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10
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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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A Data-Driven Memory-Dependent Modeling Framework for Anomalous Rheology: Application to Urinary Bladder Tissue. FRACTAL AND FRACTIONAL 2021. [DOI: 10.3390/fractalfract5040223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We introduce a data-driven fractional modeling framework for complex materials, and particularly bio-tissues. From multi-step relaxation experiments of distinct anatomical locations of porcine urinary bladder, we identify an anomalous relaxation character, with two power-law-like behaviors for short/long long times, and nonlinearity for strains greater than 25%. The first component of our framework is an existence study, to determine admissible fractional viscoelastic models that qualitatively describe linear relaxation. After the linear viscoelastic model is selected, the second stage adds large-strain effects to the framework through a fractional quasi-linear viscoelastic approach for the nonlinear elastic response of the bio-tissue of interest. From single-step relaxation data of the urinary bladder, a fractional Maxwell model captures both short/long-term behaviors with two fractional orders, being the most suitable model for small strains at the first stage. For the second stage, multi-step relaxation data under large strains were employed to calibrate a four-parameter fractional quasi-linear viscoelastic model, that combines a Scott-Blair relaxation function and an exponential instantaneous stress response, to describe the elastin/collagen phases of bladder rheology. Our obtained results demonstrate that the employed fractional quasi-linear model, with a single fractional order in the range α = 0.25–0.30, is suitable for the porcine urinary bladder, producing errors below 2% without need for recalibration over subsequent applied strains. We conclude that fractional models are attractive tools to capture the bladder tissue behavior under small-to-large strains and multiple time scales, therefore being potential alternatives to describe multiple stages of bladder functionality.
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12
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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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13
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Tuttle TG, Morhardt DR, Poli AA, Park JM, Arruda EM, Roccabianca S. Investigation of Fiber-Driven Mechanical Behavior of Human and Porcine Bladder Tissue Tested Under Identical Conditions. J Biomech Eng 2021; 143:1111616. [PMID: 34159357 DOI: 10.1115/1.4051525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Indexed: 11/08/2022]
Abstract
The urinary bladder is a highly dynamic organ that undergoes large deformations several times per day. Mechanical characteristics of the tissue are crucial in determining the function and dysfunction of the organ. Yet, literature reporting on the mechanical properties of human bladder tissue is scarce and, at times, contradictory. In this study, we focused on mechanically testing tissue from both human and pig bladders using identical protocols to validate the use of pigs as a model for the human bladder. Furthermore, we tested the effect of two treatments on tissue mechanical properties. Namely, elastase to digest elastin fibers, and oxybutynin to reduce smooth muscle cell spasticity. Additionally, mechanical properties based on the anatomical direction of testing were evaluated. We implemented two different material models to aid in the interpretation of the experimental results. We found that human tissue behaves similarly to pig tissue at high deformations (collagen-dominated behavior) while we detected differences between the species at low deformations (amorphous matrix-dominated behavior). Our results also suggest that elastin could play a role in determining the behavior of the fiber network. Finally, we confirmed the anisotropy of the tissue, which reached higher stresses in the transverse direction when compared to the longitudinal direction.
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Affiliation(s)
- Tyler G Tuttle
- Mechanical Engineering Department, Michigan State University, 474 S. Shaw Lane, East Lansing, MI 48824
| | - Duncan R Morhardt
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Andrea A Poli
- Mechanical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - John M Park
- Department of Urology, Michigan Medicine, 1500 E. Medical Drive, Ann Arbor, MI 48019
| | - Ellen M Arruda
- Mechanical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Sara Roccabianca
- Mechanical Engineering Department, Michigan State University, 474 S. Shaw Lane, East Lansing, MI 48824
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14
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Zhang X, Husmann DA, Mynderse LA, Alizad A, Fatemi M. Non-invasive assessment of urinary bladder compliance using ultrasound: first validation study based on clinical urodynamic study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:547. [PMID: 33987245 DOI: 10.21037/atm-20-6900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to validate a recently introduced non-invasive method, ultrasound bladder vibrometry (UBV), for the assessment of detrusor compliance in patients with neurogenic bladders. Methods The study was carried out on 79 adult patients with neurogenic bladders (60 male and 19 female). The UBV test was performed on each patient to measure the Lamb wave group velocity (cg ) in the anterior bladder wall at every 50mL volume increment throughout the filling phase. Bladder compliance was assessed based on the trend of Lamb wave group velocity squared (cg 2 ) versus volume. A compliance index was defined to differentiate between the compliant and non-compliant bladders. Results of the UBV compliance assessment were validated using the readings of the corresponding urodynamic studies as the clinical gold standard. Results The Patients' bladders were divided into non-compliant and compliant groups by an experienced urologist using the information in the urodynamic study (UDS) recordings. The compliance index defined on the basis of cg 2 showed a significant difference (P<0.008) between the compliant and non-compliant groups. The areas under the receiver operating characteristic curve were 0.813, with 95% CI ranging from 0.709 to 0.892. Under the optimal criterion, the bladder was considered as non-compliant if the compliance index was less than 100 mL∙s2/m2, resulting in a sensitivity and specificity of 86.4% and 71.9%, respectively. Conclusions The results of this study demonstrate that UBV can be used as a non-invasive method for the determination of bladder compliance; thus, it can potentially serve as an alternative method to UDS for the appropriate patient groups.
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Affiliation(s)
- Xinyu Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Douglas A Husmann
- Department of Urology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Lance A Mynderse
- Department of Urology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, 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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16
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Nishikawa N, Chakrabarty B, Kitney D, Jabr R, Kanai A, Fry C. Stretch- and carbachol-induced ATP release from bladder wall preparations of young and aged mice. Neurourol Urodyn 2020; 39:1644-1652. [PMID: 32531080 DOI: 10.1002/nau.24426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/19/2022]
Abstract
AIMS Bladder wall stretch increases tissue tension and releases adenosine 5'-triphosphate (ATP) as part of a transduction process to sense bladder filling. Aging is associated with bladder fibrosis to produce a stiffer bladder wall: this may augment ATP release and contribute to age-dependent urgency. Muscarinic agonists also release ATP and present a potential target for antimuscarinic agents, but its age-dependency is unknown. This study aimed, in young and old mice, to: (a) quantify the relationship between bladder wall stiffness and stretch-dependent ATP release and; (b) characterize muscarinic agonist-dependent release. METHODS ATP release from young (9-12 weeks) and aged (24 months) mouse bladder wall was measured in vitro, with a luciferin-luciferase assay, after stretch or carbachol exposure. Bladder wall stiffness, measured simultaneously during stretch, was compared to histological proportions of connective tissue and detrusor muscle. RESULTS With young mice, stretch-activated ATP release required an intact mucosa and was positively associated with wall stiffness. ATP release by carbachol was about four-fold greater compared to stretch. With aged mice: ATP release varied a hundred-fold and no association with stiffness; carbachol release diminished; connective tissue and mucosa thickness increased. CONCLUSIONS With young mice, stretch, or muscarinic agonists potently induce bladder wall ATP release. Stretch-dependent release is proportional to bladder wall stiffness, independent of the extent of stretch. With aged mice dependence of stretch-activated ATP release with stiffness was lost. The huge variability of release suggests that aged mice do not form a homogenous cohort and may underlie the heterogeneity in bladder filling sensations.
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Affiliation(s)
- Nobuyuki Nishikawa
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK.,School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Basu Chakrabarty
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| | - Darryl Kitney
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK.,School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Rita Jabr
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Anthony Kanai
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher Fry
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
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17
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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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18
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Cullingsworth ZE, Klausner AP, Li R, Nagle AS, Carroll AW, Roseman JT, Speich JE. Comparative-fill urodynamics in individuals with and without detrusor overactivity supports a conceptual model for dynamic elasticity regulation. Neurourol Urodyn 2019; 39:707-714. [PMID: 31856359 DOI: 10.1002/nau.24255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022]
Abstract
AIMS Dynamic elasticity was previously identified in individuals with overactive bladder (OAB) using comparative-fill urodynamics (UD) and is a biomechanical mechanism for acutely regulating detrusor wall tension. On the basis of this data, a conceptual model of dynamic elasticity regulation mediated through a balance of passive mechanisms and active contractions was constructed. The present study tested this model by determining whether individuals with detrusor overactivity (DO) exhibit less dynamic elasticity than individuals without DO. METHODS Individuals with and without urgency based on International Consultation on Incontinence Questionnaire-OAB surveys were prospectively enrolled in a comparative-fill UD study. An initial fill defined the presence or absence of DO and determined cystometric capacity. Three additional fills were employed with either passive emptying via a catheter or active voiding. To identify dynamic elasticity, average filling pressures (Pves ) were compared for fill 1 (before strain softening), fill 2 (after strain softening), and fill 3 (after active void). A dynamic elasticity index was defined. RESULTS From 28 participants, those without DO showed decreased Pves during filling after strain softening and restored Pves during filling following active voiding, revealing dynamic elasticity. Participants with DO did not show dynamic elasticity. A dynamic elasticity index less than 1.0 cmH2 O/40% capacity was identified in 2 out of 13 participants without DO and 9 out of 15 with DO, revealing a significant association between DO and reduced/absent dynamic elasticity (P = .024). CONCLUSIONS This study supports a conceptual model for dynamic elasticity, a mechanism to acutely regulate detrusor wall tension through a balance of competing active contractile and passive strain mechanisms. Improved understanding of this mechanistic model may help us to identify novel treatment strategies for OAB.
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Affiliation(s)
- Zachary E Cullingsworth
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rui Li
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley W Carroll
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John T Roseman
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
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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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20
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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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21
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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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22
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Use of Ultrasound Urodynamics to Identify Differences in Bladder Shape Between Individuals With and Without Overactive Bladder. Female Pelvic Med Reconstr Surg 2018; 26:635-639. [PMID: 30256268 DOI: 10.1097/spv.0000000000000638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The objective of this study was to identify differences in bladder shape changes between individuals with overactive bladder (OAB) and unaffected individuals during ultrasound urodynamics. METHODS A prospective urodynamic study was performed with concurrent transabdominal ultrasound (ultrasound urodynamics) on individuals with and without OAB based on validated International Consultation on Incontinence Questionnaire - OAB survey scores. Three-dimensional ultrasound images were acquired at 1-minute increments during filling and used to measure bladder diameters in the height, width, and depth orientations. The engineering strain for each diameter was compared between participants with OAB and controls during urodynamic filling. The height-to-width ratio at capacity was used to determine if individuals were shape outliers. RESULTS A total of 22 subjects were enrolled, including 11 with OAB and 11 without OAB. During urodynamic filling in both groups, the greatest degree of geometric strain was found in the height orientation, indicating that bladders generally fill in a craniocaudal shape. The mean ± SD height-to-width ratio of the control group was 1.06 ± 0.12 yielding a 95% confidence interval of 0.82 to 1.30. Five (45.5%) of 11 OAB subjects had height-to-width ratios outside this interval as compared with none of the control subjects, identifying a potential shape-mediated subgroup of OAB. CONCLUSIONS Three-dimensional ultrasound urodynamics can be used to identify differences in bladder shape comparing individuals with and without OAB. This method may be used to identify a subset of OAB patients with abnormal bladder shapes which may play a role in the pathophysiology of their OAB symptoms.
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23
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Naimi HA, Speich JE, Klausner AP. NEW CONCEPTS IN BLADDER SENSATION AND URINARY URGENCY. CURRENT BLADDER DYSFUNCTION REPORTS 2018; 13:132-138. [PMID: 31819779 DOI: 10.1007/s11884-018-0474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of Review The purpose of this review is to summarize the current state of knowledge regarding the evaluation and measurement of urinary urgency and bladder sensation. Recent Findings New technologies have been developed to improve our diagnostic capabilities in urinary urgency and bladder sensation. Recent developments include MRI-based neuroimaging and novel tablet-based sensation meters that can be used during urodynamics as well as during oral hydration. Summary Commonly used metrics for urinary urgency and bladder sensation include the use of validated surveys/void diaries and standardized verbal sensory thresholds during urodynamics. However, these metrics are highly subjective and prone to significant bias. There has been an evolution in evaluation metrics ranging from the use of reflex testing to electrical perception testing to the use of neuroimaging and the development of sensation meters. Neuroimaging allows for mapping of specific brain areas involved in the different phases of voiding and provides an anatomic basis for different forms of overactive bladder. The sensation meter allows for generation of real-time sensation-capacity curves which enables easy and objective comparison between patients as well as potential sub-typing of different forms of overactive bladder. In addition, new research supports the concept of differing forms of urgency and the use of novel patient-derived terminologies for urinary urgency and bladder sensation.
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Affiliation(s)
- Hameeda A Naimi
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University School of Engineering, Richmond, Virginia
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia & the Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
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