Bladder wall thickness in normal adults and men with mild lower urinary tract symptoms and benign prostatic enlargement

There is evidence that increased bladder wall thickness can be a useful parameter in the evaluation of men with clinical benign prostatic hyperplasia (BPH). However, normal values for bladder wall thickness (BWT) in adults have not been established. BWT was measured by suprapubic ultrasonography. Bladder volume was calculated as the product of the ultrasonographic measurements of bladder height, width and depth, and a correction factor (0.6). Three groups were assessed: men with normal lower urinary tracts (n = 172; mean age, 39.9), women with normal lower urinary tracts (n = 166; mean age, 37.8), and men with mild lower urinary tract symptoms (LUTS) and clinical benign prostatic enlargement (BPE) (n = 150; mean age, 66.4). For the whole group of men and women with normal bladders, mean BWT was 3.35 mm, and BWT appeared normally distributed. There were a weak negative correlation with bladder volume (r = -0.12, P < 0.003) and a weak positive correlation for BWT and age for both men (r = 0.12, P < 0.014) and women (r = 0.17, P < 0.013). Mean BWT was 3.04 mm in healthy women, 3.33 mm in healthy men, and 3.67 mm in men with LUTS and BPE. Sub-dividing normal men into different age groups showed an increasing mean BWT of 3.08 mm (<20 years, n = 27), 3.25 mm (21-40 years, n = 75), 3.42 mm (41-60 years, n = 39), and 3.57 mm (>60 years, n = 31) for those sub-groups. BWT in normal adult women is 3.0 +/- 1 mm and 3.3 +/- 1. 1 mm in normal adult men. A small increase in BWT with age is seen for both genders, and BWT tends to be greater in men than in women. Men with LUTS and BPE show a moderate increase in BWT. Adjustments for bladder volume are for practical purposes negligible, although there is a small decrease in BWT with increasing volume.

Ultrasound: a noninvasive screening test for detrusor instability

OBJECTIVE

To determine whether transvaginal ultrasound measurement of bladder wall thickness can be used as a screening test for detrusor instability in women with urinary symptoms.

DESIGN

A blinded prospective study.

SETTING

A London teaching hospital.

PARTICIPANTS

One hundred and eight-four symptomatic women presenting to a urodynamic clinic.

MAIN OUTCOME MEASURE

The detection of detrusor instability by means of videocystourethrography (VCU) and ambulatory urodynamics in women with a mean bladder wall thickness of greater than 5 mm measured by transvaginal ultrasound.

RESULTS

One hundred and eight women had a mean bladder wall thickness of greater than 5 mm. Ninety-four percent (102) of these women had detrusor instability either when undergoing VCU or ambulatory urodynamics. Seventeen women had a bladder wall thickness of less than 3.5 mm of whom three were found to have detrusor instability on VCU.

CONCLUSION

The measurement of a mean bladder wall thickness greater than 5 mm with transvaginal ultrasound is a sensitive screening method for diagnosing detrusor instability in symptomatic women without outflow obstruction.

Relationship of voiding dysfunction to urinary tract infection and vesicoureteral reflux in children

A total of 109 children were evaluated for urinary tract infections or for voiding dysfunction without infections. The relationship of voiding dysfunction to urinary infection and vesicoureteral reflux was then examined in girls. The number of males studied was too small for statistical analysis. While 40.6 percent of females with infections had voiding dysfunction, in 66.6 percent of those females having voiding dysfunction infections also developed. Voiding dysfunction was noted in 33.3 percent of females with reflux, probably due to the strong association of reflux and infections. However, all of females with voiding dysfunction, only 20.6 percent also had reflux. These findings were statistically significant (p = 0.01) and suggest that voiding dysfunction is common in girls with infections, perhaps even predisposing to the development of infections. However, voiding dysfunction in this population did not predispose to reflux.

Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach

This article reviews the different applications of ultrasound in benign urogynecological diseases. The findings presented here were obtained by introital and transvaginal ultrasound, both of which can be performed with the same equipment (5-7-MHz sector transducer, emission angle of at least 90 degrees; for introital sonography, the transducer is placed over the external urethral orifice with the transducer axis corresponding to the body axis). Female voiding dysfunction, including urge symptoms, recurrent urinary tract infections and urinary incontinence, may occur secondary to morphological and topographical changes of the urogenital organs. Findings such as urethral diverticula, periurethral masses, funneling of the urethra and distension cystoceles are identified by introital ultrasound. Transvaginal ultrasound enables the detection of pathologies of the bladder and uterus including its appendages. Ultrasound as part of the diagnostic work-up of stress urinary incontinence and genitourinary prolapse allows for the morphological and dynamic assessment of the lower urinary tract. It is possible, for example, to classify sonographically identified changes of the endopelvic fascia as lateral (distraction cystocele, funneling of the urethra) and central (pulsation cystocele) defects as well as to determine the reactivity of the pelvic floor muscles. Ultrasound has replaced radiography in yielding information on the abnormal morphology of the urogenital organs, which should be taken into account in planning the treatment of urogynecological conditions.

Female pelvic organ prolapse and voiding function

It is accepted that pelvic organ prolapse impairs voiding, in particular as regards the anterior vaginal wall. The influence of central and posterior prolapse is more controversial. Mechanical effects, i.e. urethral distortion and compression, have been advanced as causative mechanisms. This study attempts to further elucidate the effect of prolapse on voiding. We investigated 228 patients with symptoms of lower urinary tract dysfunction and/or prolapse using independent flowmetry, clinical and ICS prolapse assessment and translabial ultrasound. As expected, age ( P<0.001), previous hysterectomy ( P = 0.002) and/or incontinence surgery ( P<0.001) negatively influenced flow. As regards prolapse, only enterocele had a consistently negative effect on flow ( P<0.001 for clinical staging, P = 0.002 for ICS assessment, P = 0.005 for ultrasound imaging). The relationship between anterior vaginal wall prolapse and voiding was complex: funneling and opening of the retrovesical angle on ultrasound was associated with improved voiding ( P<0.001), but a cystocele with intact retrovesical angle had the opposite effect ( P<0.001).

Four-contrast defecography: pelvic "floor-oscopy"

PURPOSE

This study was designed to determine the accuracy of physical examination (as judged by four-contrast defecography) for women with pelvic floor relaxation disorders.

METHODS

Sixty-two women (mean age, 59 years) who had obstructed defecation or constipation, vaginal prolapse, urinary difficulty, or pelvic pain underwent four-contrast defecography. Oral, vaginal, bladder, and rectal contrast were administered selectively and fluoroscopy was performed. Radiographic findings were compared with physical examination diagnosis.

RESULTS

Four-contrast defecography changed the diagnosis in 46 patients (75 percent); 26 percent of presumed cystoceles, 36 percent of enteroceles, and 25 percent of rectoceles were not present on defecography. Defecography also revealed unsuspected coexisting defects in addition to known abnormalities detected on physical examination. In contrast, when physical examination was negative for these defects, 63 percent of patients were found to have cystoceles, 46 percent to have enteroceles, and 73 percent to have rectoceles on four-contrast defecography. The discovery of Grade 2 or 3 unsuspected abnormalities was significant, especially so for enteroceles. For posterior vaginal eversions extending to or past the introitus, physical examination was accurate in only 61 percent. Physical examination of large anterior defects was more accurate, with 74 percent of patients being correctly diagnosed.

CONCLUSIONS

Physical examination diagnosis of pelvic floor relaxation disorders is frequently inaccurate, especially for large vaginal eversions. Four-contrast defecography improves diagnostic accuracy, helps to identify all pelvic floor defects before surgery, and can assist with planning the correct operative approach.

A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women

OBJECTIVE

To compare the effects of oral and vaginal estrogen therapy (ET) on the lower urinary tract in postmenopausal women with prior hysterectomy.

DESIGN

Randomized, prospective study.

SETTING

Tertiary teaching hospital.

PATIENT(S)

Fifty-seven hysterectomized, postmenopausal women.

INTERVENTION(S)

Patients were randomized to receive either oral (0.625 mg of conjugated equine E per tablet; n = 27) or topical (0.625 mg conjugated equine E per 1 g vaginal cream; n = 30) E, administered once daily.

MAIN OUTCOME MEASURE(S)

All subjects had E2 measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews with the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 3 months after ET.

RESULT(S)

A higher serum level of E2 was noted in the oral group compared with the topical group after ET. The post-ET pulsatility index of periurethral vessels and bladder neck revealed statistically significant decreases in both groups. The incidences of urinary frequency and nocturia were significantly decreased after 3 months of ET in both groups. Changes in the incidence of other symptoms, including stress incontinence and urge incontinence, were not statistically significant. However, subjective improvement of stress incontinence was found in 72.7% of the oral group and 60% of the topical group.

CONCLUSION(S)

The results suggest that ET alone, by an oral or vaginal route, could increase the blood flow around the bladder neck and mid-urethra and relieve the symptoms of overactive bladder and stress incontinence in postmenopausal women with prior hysterectomy. In addition, vaginal preparations are as effective as systemic therapy at the lower serum level of E2.

Premedication with oral midazolam for voiding cystourethrography in children: safety and efficacy

OBJECTIVE

Midazolam is a relatively short-acting water-soluble benzodiazepine that provides anxiolysis and anterograde amnesia and can be given orally with few adverse effects. We evaluated the benefit and safety of oral midazolam for sedation of young children during voiding cystourethrography or nuclear cystography.

SUBJECTS AND METHODS

For 3.5 years, a highly selected group of 98 children, ages 23 months to 9 years (mean, 4 years), were given oral midazolam 0.6 mg/kg 20-30 min before cystourethrography or nuclear cystography. These children either had been frightened by a previous catheterization (39%) or seemed particularly frightened during an examination of their genitals in the office (61%). A control group of 25 children, similar in age to the study group, did not receive midazolam before cystourethrography. Parents were interviewed to assess their child's recollection of the procedure. Voiding dynamics were assessed by evaluating the postvoiding radiograph.

RESULTS

Of the midazolam-treated patients, 60% had no recollection of the study, and 31% remembered part or all of the study but did not have a negative experience. No significant change in vital signs or oxygen saturation was observed in any child. In the control group, 24 (96%) of 25 children remembered the cystographic examination (p < .01). Behavioral side effects occurred in 12% of the children receiving midazolam and consisted primarily of combative behavior as the medication was wearing off. Ninety-five percent of the parents indicated that they would want their child to have midazolam again if the cystography needed to be repeated. Of the children receiving midazolam, 76% had little or no residual urine after voiding, compared with 72% of the control group (no significant difference).

CONCLUSION

In children who have been or are likely to be excessively frightened during cystourethrography or nuclear cystography, midazolam usually provides satisfactory amnesia and anxiolysis with few side effects or adverse impact on voiding dynamics.

Urinoma

A urinoma is a mass formed by encapsulated extravasated urine. It may follow closed renal injury, surgical operation or arise spontaneously in the presence of obstruction. The essential factors are continued renal function, rupture of the collecting system and distal obstruction. The extravasating urine is localised within the perirenal fascia and stimulates an intense fibrous reaction which forms a thick wall. Early diagnosis is important for successful treatment. The clinical features include malaise, vague abdominal pain, weight loss and a palpable mass. Plain films usually reveal a mass with loss of the retroperitoneal landmarks. High-dose excretion urography usually shows renal displacement, hydronephrosis and extravasation of contrast medium into the urinoma. Should renal function be inadequate for diagnosis, renal puncture, preceded by ultrasound examination, is the investigation of choice.

Preliminary results of power Doppler imaging in benign prostatic hyperplasia

Power Doppler imaging was performed in 77 patients with lower urinary tract symptoms to characterize Doppler blood-flow signals in benign prostatic hyperplasia (BPH). Pulsatile blood flows were detected in all patients, demonstrating a significant increase of the resistive index (RI) in BPH cases (n = 40, 0.72 +/- 0.05, p < 0.0001), compared to those with a healthy prostate (n = 37, 0.64 +/- 0.04). Of 40 patients with BPH, 28 (70%) had an RI of 0.70 or higher; all but 1 patient with a healthy prostate (1 of 37, 3%) had an RI lower than 0.70 (p < 0.0001). In all 10 patients with BPH, the elevated RI decreased significantly to a normal control level after surgical treatment (0.72 +/- 0.02 vs. 0.64 +/- 0.05, p < 0.001). In conclusion, Doppler RI might be useful as a new urodynamic parameter in BPH.

Establishing a Mean Postvoid Residual Volume in Asymptomatic Perimenopausal and Postmenopausal Women

OBJECTIVE

To estimate mean postvoid residual (PVR) volumes among perimenopausal and postmenopausal women without significant lower urinary tract or pelvic organ prolapse symptoms.

METHODS

Patients presenting for well-women encounters were offered study participation. Women with a history of urinary incontinence greater than twice per week, urinary retention, symptomatic pelvic organ prolapse, or neurologic disorders were excluded. Pelvic relaxation, if present, was characterized according to the pelvic organ prolapse quantification system. Within 10 minutes of spontaneously voiding, PVR volume was assessed with bladder ultrasonography.

RESULTS

A total of 96 patients were enrolled; mean age was 60+/-11 years. The majority (80%) were postmenopausal; 30% had a previous hysterectomy. Most women (92%) had some degree of prolapse; the median stage was one, most commonly involving the anterior compartment (70%). The median PVR volume was 19 mL (range 0-145 mL); the mean PVR volume was 24+/-29 mL. Only 15% of patients had a PVR volume greater than 50 mL, and 95% had a PVR volume 100 mL or less. Only age 65 years or older was associated with a higher mean PVR volume; hormone therapy, vaginal atrophy, parity, and stage of asymptomatic prolapse did not affect PVR volumes.

CONCLUSION

Most asymptomatic perimenopausal and postmenopausal women had a PVR volume less than 50 mL, which was unaffected by multiple factors that were thought to potentially affect bladder function. Establishing "normal" volumes in this population may aid in developing recommendations regarding appropriate bladder function and retention criteria for women who are symptomatic or those who have had pelvic floor surgery.

Doppler resistive index in benign prostatic hyperplasia: correlation with ultrasonic appearance of the prostate and infravesical obstruction

OBJECTIVE

This study was designed to characterize the resistive index (RI) of prostatic blood flows obtained by transrectal power Doppler sonography (TRPDS) in benign prostatic hyperplasia (BPH).

METHOD

In 140 patients with lower urinary tract symptoms, the RI was measured using TRPDS and compared with age and planimetric parameters of the prostate obtained by conventional transrectal sonography. In addition, the RI was related with pressure flow studies.

RESULTS

The RI was significantly higher in patients with BPH (0.72+/-0.06, p<0.0001) than those with a normal prostate (0. 64+/-0.04). Although the RI correlated significantly with age and all prostatic planimetric parameters, multiple regression analysis revealed that age and presumed circle area ratio were independent predictors for RI. The RI was also higher in patients with infravesical obstruction than those without (0.74+/-0.06 vs. 0. 70+/-0.05, p<0.005). There was a significant correlation between RI and urodynamic parameters obtained in pressure flow studies. Out of 33 patients with obstruction, 28 (85%) had an RI of 0.7 or more, while 11 out of 24 patients (46%) without obstruction had an RI less than 0.7.

CONCLUSION

The RI is promising as a new parameter to estimate the intraprostatic pressure to investigate BPH. Its value to represent urodynamic information during voiding remains to be studied.

Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms

OBJECTIVES

To evaluate the association of prostatic urethral angle (PUA) with bladder outlet obstruction (BOO) index in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

METHODS

A retrospective analysis was made of 260 men with LUTS and/or BPH aged>50 years (median: 65.9, range: 50-87). Patients underwent an evaluation including the International Prostatic Symptom Score, serum prostate-specific antigen levels, transrectal ultrasonography, frequency-volume chart, uroflowmetry, and measurement of postvoid residual, and multichannel video urodynamic study with a pressure-flow study.

RESULTS

Patients with higher PUA (PUA>or=35 degrees) had higher prostate-specific antigen levels (P=.043), larger prostate volume (P<.001), higher maximal urethral closure pressure (P=.004), higher detrusor pressure at maximum flow rate (P=.008), and higher BOO index (P=.032), in comparison with those who had lower PUA (PUA<35 degrees). There was no significant difference of PUA values according to the degree of intravesical prostatic protrusion. When we compared BOO index according to PUA, patients with higher PUA had higher BOO index than those with lower PUA (30.6+/-1.8 vs 23.6+/-1.8, P=.006). The area under the curve of PUA was significant for BOO (area, 63.0%; 95% confidence interval, 55.1%-70.9%; P=.002).

CONCLUSIONS

PUA may be one method to asses the presence of BOO in men with LUTS and/or BPH. Our findings suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.

Lower urinary tract dysfunction as persistent complication of radical hysterectomy

BACKGROUND

This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy.

METHODS

We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years age (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies.

RESULTS

Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients.

CONCLUSION

All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow-up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.

SEDATION DURING VOIDING CYSTOURETHROGRAPHY: COMPARISON OF THE EFFICACY AND SAFETY OF USING ORAL MIDAZOLAM AND CONTINUOUS FLOW NITROUS OXIDE

PURPOSE

We compare the efficacy and safety profile of oral midazolam and continuous flow 50% nitrous oxide (N(2)O) for alleviating anxiety and pain during voiding cystourethrography (VCU) in children.

MATERIALS AND METHODS

This prospective, randomized clinical trial study was conducted in the radiology unit of a tertiary care center. Children older than 3 years scheduled for VCU were given either 0.5 mg/kg midazolam orally or continuous flow 50% N(2)O. Main outcomes were degree of anxiety and pain as assessed by the attending nurse and radiologist performing the test using a behavioral anxiety score, a distress score and an overall satisfaction score, side effects and recovery profile.

RESULTS

The study included 47 children (89% girls) with a mean age of 6 years (range 3 to 15). There were 24 subjects in the midazolam group and 23 in the N(2)O group. Midazolam and N(2)O provided adequate anxiety and pain relief to perform the examination, yet children given N(2)O required less restraining and experienced a significantly shorter recovery time (29 +/- 10 vs 63 +/- 25 minutes, p <0.001).

CONCLUSIONS

Continuous flow 50% nitrous oxide and oral midazolam are comparably safe and effective in reducing anxiety and distress during VCU in children older than 3 years. However, N(2)O provides a more rapid onset of sedating effect and has a shorter recovery time.

Bladder wall thickness on ultrasonographic cystourethrography: affecting factors and their implications

OBJECTIVE

To explore factors affecting bladder wall thickness on ultrasonographic cystourethrography in female patients with lower urinary tract symptoms.

METHODS

The records of 492 female patients with lower urinary tract symptoms who had undergone a urodynamic study and ultrasonography of the lower urinary tract and who had normal urinalysis findings, negative urine culture results, or both were identified from our urogynecologic database. These included 248 patients with urodynamic stress incontinence, 38 with detrusor overactivity, 39 with mixed incontinence, 35 with a hypersensitive bladder, 42 with voiding difficulty, and 90 with normal urodynamic findings.

RESULTS

Age, resting bladder neck angle, urethral mobility, and maximum urethral closure pressure were significantly associated with bladder wall thickness at the trigone and dome. Bladder wall thickness at the trigone was correlated with that at the dome (P < .0001). Bladder wall thickness at the trigone was positively correlated with pressure transmission ratios in the first and second quarters of the urethra (P < .0001; P = .002, respectively), whereas that at the dome was positively correlated with intravesical pressure at maximum flow and with detrusor opening pressure (P = .027; P = .046, respectively). Age and intravesical pressure at maximum flow were independently associated with bladder wall thickness at the trigone and dome (P = .007; P = .028), respectively. A thickened bladder wall was a common finding in female lower urinary tract symptoms, except in the patients with a hypersensitive bladder.

CONCLUSIONS

Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both.

Establishing a Standard Protocol for the Voiding Cystourethrography

The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux. The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency department physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985. However, more recent information provided by many national and international institutions suggests a need to refine those recommendations. The lead author of the 1985 study, R.L. Lebowitz, agreed to and participated in the current protocol. In addition, a recent survey directed to the chairpersons of pediatric radiology of 65 children's hospitals throughout the United States and Canada showed that VCUG protocols vary substantially. Recent guidelines from the American Academy of Pediatrics (AAP) recommend a VCUG for children between 2 and 24 months of age with urinary tract infections but did not specify how this test should be performed. To improve patient safety and to standardize the data obtained when a VCUG is performed, the AAP Section on Radiology and the AAP Section on Urology initiated the current VCUG protocol to create a consensus on how to perform this test.

Prevalence of spina bifida occulta in patients with functional disorders of the lower urinary tract and its relation to urodynamic and neurophysiological measurements

OBJECTIVE

To determine the relation between neurophysiological abnormalities and the radiological detection of spina bifida occulta in patients with dysfunction of the lower urinary tract.

DESIGN

Blind assessment and subsequent decoding of mixed batch of abdominal radiographs from patients with and without urological symptoms for evidence of spina bifida occulta and comparison of results with those of previous control series.

SETTING

Review study among tertiary referrals to an incontinence clinic of a city hospital.

PATIENTS

One hundred and thirty eight adults with proved urodynamic abnormalities in whom neurophysiological measurements were available.

INTERVENTIONS

None.

END POINT

Correlation of neurophysiological abnormalities in lower urinary tract dysfunction with presence and type of spina bifida occulta and level of opening of posterior sacral arcs.

MEASUREMENTS AND MAIN RESULTS

On decoding radiographs those from patients without urological symptoms showed a similar prevalence of spina bifida occulta to that in the control series (631/2707 controls; 23%). By contrast, patients with urological symptoms had a significantly increased prevalence of spina bifida occulta at S1 and S2 and a higher level of opening of posterior sacral arcs. The increased prevalence of the bony defect was particularly striking in men with urgency and instability and in women with stress incontinence. No significant correlation was found between any particular neurophysiological abnormality and the presence of spina bifida.

CONCLUSIONS

In patients with dysfunction of the lower urinary tract neurophysiological abnormalities may be associated with congenital dysraphic lesions in the lower lumbar spine and sacrum. There appears to be no direct causal relation between the radiological and neurophysiological abnormalities but the findings suggest a common aetiological factor.

Discrimination of bladder disorders in female lower urinary tract symptoms on ultrasonographic cystourethrography

OBJECTIVE

To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics.

METHODS

Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver.

RESULTS

Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck.

CONCLUSIONS

Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability.

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.