Comparison between bladderscan, real-time ultrasound and suprapubic catheterisation in the measurement of female residual bladder volume

Accuracy of postvoid residual volumes after vaginal delivery: a prospective equivalence study to compare an automatic scanning device with transurethral catheterization

Introduction and hypothesis

Abnormal postvoid residual volumes (PVRV) after delivery are common in daily clinical practice. By using an automatic scanning device, unnecessary catheterizations can be prevented. The aim of this study was to determine the accuracy of PVRV after vaginal delivery measured by an automatic scanning device through a comparison with transurethral catheterization.

Materials and methods

This prospective observational equivalence study was performed in patients who delivered vaginally between June 2012 and May 2017 in three teaching hospitals in The Netherlands. After the first spontaneous void after delivery, postvoid residual volume (PVRV) was measured with a portable automatic scanning device (BladderScan® BVI 9400). Directly afterward, it was measured by catheterization. Correlation between measurements was calculated using Spearman’s correlation coefficient and agreement plot. The primary outcome was to validate the correlation between the BladderScan® compared with the gold standard of transurethral catheterization.

Results

Data of 407 patients was used for final analysis. Median PVRV as measured by BladderScan® was 380 ml (± 261–0–999 ml) and by catheterization was 375 ml (± 315–1800 ml). Mean difference between measurements was −12.9 ml (± 178 ml). There was a very good correlation between methods (Spearman’s rho = 0.82, p < 0.001). Using a cut-ff value of >500 ml, specificity and sensitivity were 85.4 and 85.6%, respectively.

Conclusions

The BladderScan® (BVI 9400) measures PVRV precisely and reliably after vaginal delivery and should be preferred over catheterization.

Active encouragement of older women with urinary incontinence in primary care to undergo diagnosis and treatment: a matched-pair cluster randomized controlled trial

OBJECTIVES

The URINO trial investigated the effect of offering treatment to older women with urinary incontinence in the general population, who had not sought help on their own initiative.

STUDY DESIGN

In a cluster randomized trial, 14 general practitioners were matched into pairs and randomly allocated to an intervention or a control group. Women aged ≥ 55 years registered in the participating practices were asked about urinary incontinence via a postal questionnaire. Patients in the intervention group were assessed and treated whereas patients in the control group received standard care.

MAIN OUTCOME MEASURES

Primary outcome was improvement (yes or no) of the severity of symptoms at 12-month follow-up measured with the Incontinence Severity Index. Secondary outcomes were the number of incontinence episodes per day and quality of life. The primary analysis was on an intention-to-treat basis with multiple imputation of missing data. A logistic regression model with correction for cluster randomization was fitted to estimate odds ratios (ORs).

RESULTS

At 12 months, the severity of symptoms had improved in more patients in the intervention group (n166) than in the controls (n184) (OR 1.9; 95% CI 1.1-3.3). Also, the number of patients with fewer episodes of incontinence had increased (OR 2.5; 95% CI 1.5-4.1). No between-group differences in changes in quality of life were apparent (p0.14).

CONCLUSIONS

It is recommended to encourage women in the general population aged ≥ 55 years with urinary incontinence to undergo diagnosis and treatment.

Accuracy of post-void residual urine volume measurement using a portable ultrasound bladder scanner with real-time pre-scan imaging

AIMS

To evaluate whether the bladder scanner with real-time pre-scan imaging (RPI) is superior to the conventional bladder scanner in measuring post-void residual urine (PVR) volume.

METHODS

Sixty-seven patients with voiding dysfunction were subjected to PVR volume measurements. The PVR volume was measured three times by two experienced examiners using bladder scanners with (BioCon-500, Mcube Technology, Seoul, Korea) or without (BVI-3000 BladderScan, Verathon, WA) RPI. Immediately after the procedure, urethral catheterization was performed to obtain true volume. The accuracy and variability of measurements were compared between the two devices and correlation coefficients were obtained.

RESULTS

The Pearson correlation coefficients between the PVR volume measured by each device and the true volume were 0.932 for the bladder scanner without RPI and 0.950 for the bladder scanner with RPI. The bladder scanner without RPI tended to overestimate the true volume in moderate volume ranges (>100 ml) by a mean percentage of differences of volume (PDV) of 16.3%, while the bladder scanner with RPI underestimated the true volume in the whole volume range by a mean PDV of -14.1% (P<0.001). Repeated measures ANOVA showed no significant interobserver variability (P=0.977 for the bladder scanner without RPI and P=0.853 for the bladder scanner with RPI) or intraobserver variability (P=0.660 for the bladder scanner without RPI and P=0.271 for the bladder scanner with RPI).

CONCLUSIONS

Our results showed that exact pointing to the bladder prior to actual measurement of bladder volume with RPI seems to reduce the variability of the measured values.

Portable ultrasonography and bladder volume accuracy--a comparative study using three-dimensional ultrasonography

OBJECTIVES

To compare the ultrasound bladder volume accuracy and level of agreement between two portable bladder scanners (Bladderscan and Bardscan) and a three-dimensional ultrasound (3D-US) system.

METHODS

A total of 50 healthy volunteers were scanned using the Bladderscan BVI 3000, Bardscan, and 3D-US system (HDI 4000), in random sequence. The BVI3000 is a dedicated bladder volume calculator, and the Bardscan combines real-time ultrasonography with bladder volume calculation. The ultrasound bladder volumes were compared with the voided volume measurements. The volunteers underwent repeat scanning after voiding, and those with a measurable residual volume were excluded from the final analysis.

RESULTS

A residual volume was detected in 16 subjects (32%). In the remaining 34 subjects, the mean voided volume +/- standard deviation was 252.9 +/- 167.4 mL (range 33 to 709). A significant correlation (P <0.001) was found between the voided and ultrasound volumes with all three methods (Bardscan, r = 0.97; Bladderscan, r = 0.98; and 3D-US system, r = 0.99). No significant differences were found between the voided volumes and the Bladderscan or 3D-US volumes; however, the Bardscan significantly underestimated the voided volume by a mean of 21.4 mL (t = 2.84, P = 0.0076). The Bland-Altman 95% limit of agreement between the voided and calculated volumes was -64.5 to 107.2 mL, -73.7 to 88.4 mL, and -28.9 to 40.0 mL for the Bardscan, Bladderscan, and 3D-US systems, respectively.

CONCLUSIONS

The results of our study have shown that although the Bardscan has the advantages of real-time scanning with portability and instantaneous volume calculation, it is not as accurate as the Bladderscan. The accuracy and level of clinical agreement was greatest when using the 3D-US system to calculate the bladder volume.

The effectiveness of implementing a bladder ultrasound programme in neurosurgical units

AIM

This paper reports an evaluation of the differences among rates of unnecessary catheterization, urinary retention and urinary tract infection before and after implementing a bladder ultrasound programme to assess urine volume.

BACKGROUND

Bladder ultrasound is a non-invasive alternative to urethral catheterization for the determination of bladder urine volume. Much of the literature available on bladder ultrasound technology addresses the accuracy of the equipment, with little research on the clinical outcomes or benefits of the intervention.

METHODS

A quasi-experimental design was adopted. Data were collected from March 2001 to May 2001 in a control group in two neurosurgical units in Taiwan. During July and August 2001, nurses were taught how to operate a portable ultrasound machine and how to implement the programme. Data were collected from September to November 2001 in the study group.

RESULTS

The rates of unnecessary catheterization in the control group and the study group were 35.3% and 7.0%, respectively. The urine volume (more than 500 mL) in the control group and the study group were 13.4% and 20.3%, respectively. The study group had a statistically significantly lower average catheterization volume than that of the control group (676.9 mL vs. 777.1 mL, t = 1.84, P < 0.05). During 3 months before and after the implementation of the programme, the urinary tract infection rates in the control group and the study group were 3.47% and 2.87%, respectively. After 6 months the urinary tract infection rates decreased to 1.39%.

CONCLUSION

The bladder ultrasound programme was successful and could be used to manage patients with urination disorders in neurosurgical units.