Three-dimensional measurement and analysis of benign prostatic hyperplasia

Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study

Background

Benign prostatic hyperplasia (BPH) is the most common benign disease causing voiding dysfunction in middle-aged and elderly men. the current "gold standard" for surgical treatment is transurethral resection of the prostate (TURP). Continuous bladder irrigation (CBI) is routinely given for 3 to 5 days after operation. However, this may induce bladder spasm. Bladder spasm not only brings physical and mental pain to patients, delaying the postoperative recovery process, but it also increases the medical economic burden. Therefore, it is important to take active measures to effectively warn and deal with bladder spasm. The color of the drainage fluid is an important indicator and requires close observation during CBI, as it can reflect real-time postoperative bleeding. When the color of drainage fluid is abnormal, effective measures should be undertaken. Grading nursing intervention divides patients into different conditions according to their possible changes, and then recommends targeted nursing intervention. Existing studies have formulated CBI programs from the perspective of quantifying the relationship between drainage fluid color and irrigation speed, but have yet to incorporate bladder spasm prevention and control levels or design corresponding grading nursing intervention programs according to different drainage fluid colors. This study aimed to construct the risk warning classification and intervention plan of bladder spasm under the guidance of CBI speed adjusting card after TURP.

Methods

Based on the rate adjustment card of CBI after TURP, we formulated the first draft of an early warning classification of risk in bladder spasm and its intervention plans by combining methods suggested from a literature search with semi-structured interviews and results from 2 rounds of correspondence inquiries with 28 experts by the Delphi method. We further screened and revised grading standards and measures.

Results

The positive coefficients of experts in 2 rounds of correspondence inquiries were both 100%, the authority coefficients were both 0.952, and the Kendall harmony coefficients were 0.238 and 0.326, respectively (P<0.01). In the second round of correspondence inquiries, the coefficient of variation of expert opinions was 0.000-0.154, and the coefficient of variation of all items was <0.25. Finally, a 3-level risk warning classification standard and 23 nursing measures for CBI complicated by bladder spasm was constructed.

Conclusions

The early warning classification of risk in bladder spasm and its intervention plans guided by rate adjustment card of CBI after TURP are scientific and feasible, and can provide a basis and guidance for effective and standardized CBI in patients after TURP.

Evaluation of pelvic structural abnormalities in primiparous women with stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the morphological characteristics of pelvic floor structure specific to de novo stress urinary incontinence (SUI) in primiparous women using three-dimensional (3D) reconstruction fusion technology based on static MRI combined with dynamic MRI.

METHODS

Eighty-one primiparous women after the first vaginal delivery were studied, 40 with SUI and 41 without SUI. 3D reconstruction models based on static MRI were used to describe the anatomical abnormalities of pelvic floor tissues. Dynamic MRI was used to describe segmental activities of the urethra and vagina. The relationship between the morphometry and postpartum SUI was evaluated by logistic regression analysis and receiver operator characteristic curve.

RESULTS

The differences in the distance from the bladder neck to the pubic symphysis (BSD), the angle between the posterior wall of the urethra and the anterior wall of the vagina, the width of the distal region of the vagina, urethral length, urethral compression muscle volume (CUV), and pubovisceral muscle volume, puborectal muscle volume, were measured, and except for the extremity of the anterior urethral wall, the total displacements (TDs) of the other sites between the two groups were statistically significant (p < 0.05). Logistic regression analysis showed that the BSD decreased, the CUV decreased, the TDs of the first site and the eighth site increment correlated significantly with postpartum SUI occurrence (p < 0.05).

CONCLUSIONS

3D reconstruction fusion technology provides an important support for a precise assessment of the pelvic floor dysfunction. The BSD, CUV, and iliococcygeus muscle volume have certain values in predicting de novo SUI after first vaginal birth.

A retrospective study of 3D measurement and analysis applied in the morphological evaluation of achalasia cardia

Background

Achalasia cardia (AC) is defined as a disorder of esophageal motility whose diagnostic gold standard depends on high-resolution manometry (HRM). The invasiveness of HRM can cause difficulties in diagnosis, treatment, and follow-up for patients with AC. Thus, we aimed to investigate the function of 3D reconstruction and measurement to prove the wide application of this alternative non-invasive approach for AC.

Methods

A total of 126 patients with AC and 40 healthy subjects in Tianjin Medical University General Hospital from January 2018 to October 2022 were enrolled in this retrospective study. Chest CT images of these subjects were used to reconstruct the 3D models of the esophagus, stomach, spine, left crus, and right crus. Measurements of esophagus length, volume of esophagus, gastroesophageal insertion angle (His angle), max thickness of esophageal wall, esophagus maximum transverse and longitudinal diameter, esophagus-spine angle, and spine-lower esophageal sphincter (LES) angle were applied based on the models.

Results

Retrocardiac esophagus length, volume of esophagus, max thickness of esophageal wall, esophagus maximum transverse and longitudinal diameter, thoracic esophagus-spine angle, and spine-LES angle in the AC group were higher than those in the control group (all P values <0.05). Among the three subtypes of AC, thoracic esophagus length, intra-abdominal LES length, volume of esophagus, His angle, esophagus maximum transverse and longitudinal diameter, and thoracic esophagus-spine angle all presented statistical differences (all P values <0.05). Correlation analysis revealed that manometric types were positively associated with His angle [r=0.196; 95% confidence interval (CI): 0.009, 0.372; P=0.028] but negatively associated with volume of esophagus (r=-0.480; 95% CI: -0.639, -0.310; P<0.001), esophagus maximum transverse diameter (r=-0.551; 95% CI: -0.679, -0.400; P<0.001), esophagus maximum longitudinal diameter (r=-0.518; 95% CI: -0.649, -0.366; P<0.001), and thoracic esophagus-spine angle (r=-0.324; 95% CI: -0.479, -0.157; P<0.001).

Conclusions

This study successfully presented the differences in esophageal length, volume, thickness, and angles between healthy subjects and different AC subtypes on the basis of 3D reconstruction and measurement. Thus, 3D model and measurement can be regarded as a good support for further research and make a valuable contribution to developing non-invasive approaches for AC management.

Multiparametric Magnetic Resonance Imaging With Comprehensive Assessment of Prostate Volume, Morphology, and Composition Better Reflects the Correlation With International Prostate Symptom Score

OBJECTIVE

To investigate the application of multiparametric magnetic resonance imaging (mp-MRI) for comprehensive evaluation of the correlation between the characteristics of the transitional zone and the International Prostate Symptom Score (IPSS) in patients with benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

We retrospectively recruited 210 patients with biopsy-proven BPH who underwent preoperative mp-MRI and were assigned an IPSS. The evaluation indicators included prostate volumetric parameters (total prostate volume [TPV], transition zone volume [TZV], and transition zone index [TZI, TZI=TZV/TPV]), prostate morphological parameters (intravesical prostatic protrusion, and presumed circle area ratio) and prostate compositional parameters (apparent diffusion coefficient [ADC], and mean signal intensity of T2WI [mean-SI-T2WI]). The Pearson (r) correlation coefficient, one-way analysis of variance, and multiple linear regression analysis were used to build a regression model for evaluating the correlation between MRI-derived parameters and IPSS, IPSS-storage symptom, IPSS-voiding symptom.

RESULTS

Significant correlations were found between IPSS, IPSS-storage symptom, IPSS-voiding symptom, and prostate MRI-derived parameters, including TPV (r = 0.350; r = 0.466; r = 0.225, P < .001), TZV (r = 0.374; r = 0.492; r = 0.243, P < .001), TZI (r = 0.383; r = 0.313; r = 0.354, P < .001), presumed circle area ratio (r = 0.481; r = 0.356; r = 0.469, P < .001), ADC(r = -0.198; r = -0.053; r = -0.239, P < .05) and mean-SI-T2WI (r = -0.626; r = -0.310; r = -0.687, P < .001), respectively. Based on multiple linear regression analysis, the impact of mean-SI-T2WI and TZI on total IPSS were statistically significant (P < .05), and the regression equation established with the analysis (IPSS= 39.224 + 8.469 ×TZI+ (-0.09)× (mean-SI-T2WI)) was statistically significant (F=104.995, P < .001).

CONCLUSION

Mp-MRI could be used to evaluate the volume and morphology of BPH. In particular, mean-SI-T2WI and ADC could be used to describe the internal composition of the prostate. The imaging parameters were effective for evaluating BPH.

Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models

Objective

Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models.

Methods

Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression.

Results

Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS.

Conclusions

Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.