[Transurethral Resection of Necrotic Tissue in the Bladder Caused by Emphysematous Cystitis].

Emphysematous cystitis is a relatively rare form of urinary tract infection. A 72-year-old man with diabetes mellitus and long-term indwelling urethral catheterization was diagnosed with emphysematous cystitis. The clinical findings were resolved by conservatively managing the patient with antibiotics. However, cystoscopy subsequently revealed a yellowish-white soft tissue mass in the bladder, which was unlikely to be a bladder tumor. The mass could not be removed easily and frequently caused urinary catheter obstruction. We successfully removed this mass by performing transurethral resection twice. Through histopathological examination, the mass was identified as necrotic tissue comprising bacteria, fibrin, and suspected bladder mucosa.

Kidney, ureter, and urinary bladder segmentation based on non-contrast enhanced computed tomography images using modified U-Net.

This study was performed to segment the urinary system as the basis for diagnosing urinary system diseases on non-contrast computed tomography (CT). This study was conducted with images obtained between January 2016 and December 2020. During the study period, non-contrast abdominopelvic CT scans of patients and diagnosed and treated with urinary stones at the emergency departments of two institutions were collected. Region of interest extraction was first performed, and urinary system segmentation was performed using a modified U-Net. Thereafter, fivefold cross-validation was performed to evaluate the robustness of the model performance. In fivefold cross-validation results of the segmentation of the urinary system, the average dice coefficient was 0.8673, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9651, 0.7172, and 0.9196, respectively. In the test dataset, the average dice coefficient of best performing model in fivefold cross validation for whole urinary system was 0.8623, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9613, 0.7225, and 0.9032, respectively. The segmentation of the urinary system using the modified U-Net proposed in this study could be the basis for the detection of kidney, ureter, and urinary bladder lesions, such as stones and tumours, through machine learning.

Differences in bladder neck angles between female patients with overactive bladders and healthy peers.

AIM: The aim of this study was to compare the differences between angles of bladder neck in girls with overactive bladder and those in healthy ones using transabdominal ultrasonography. MATERIALS AND METHODS: This study consists of 28 girls complicated with overactive bladder (Group I) and 40 healthy girls (Group II). The anteroposterior vesical wall angle (APVA), urethroposterior vesical wall angle (UPVA), urethroanterior vesical wall angle (UAVA), thickness of bladder mucosa, distance of urethral orifices, and distance between ureter and urethra orifice were measured in supine position using transabdominal ultrasonography. The results were compared between the two groups. RESULTS: UAVA in Group I was higher than Group II (135.2 ± 12.2 mm vs. 117.4 ± 14.0 mm; p = 0.009). UPVA was smaller in Group I than Group II (114.6 ± 19.5 mm vs. 135.3 ± 16.5 mm; p = 0.014). The distance between the ureteral orifices was 31.8 ± 8.5 mm in Group I and 17.0 ± 4.1 mm in Group II (p < 0.001). There was no statistically significant difference between groups in terms of APVA, bladder mucosa thickness, and distance between ureter and urethra orifice (p > 0.05). CONCLUSION: Bladder neck dynamics may play an important role in overactive bladder pathophysiology due to differences in UPVA, UAV, and location of ureteral orifices in this patient population.

MRI-based radiomic features of the urinary bladder wall identify patients with moderate-to-severe international prostate symptom score.

BACKGROUND: The International Prostate Symptom Score (IPSS) is a patient-reported measurement to assess the lower urinary tract symptoms of bladder outlet obstruction. Bladder outlet obstruction induces molecular and morphological alterations in the urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, and nerves. We sought to analyze MRI-based radiomics features of the urinary bladder wall and their association with IPSS. METHOD: In this retrospective study, 87 patients who had pelvic MRI scans were identified. A biomarker discovery approach based on the optimal biomarker (OBM) method was used to extract features of the bladder wall from MR images, including morphological, intensity-based, and texture-based features, along with clinical variables. Mathematical models were created using subsets of features and evaluated based on their ability to discriminate between low and moderate-to-severe IPSS (less than 8 vs. equal to or greater than 8). RESULTS: Of the 7,666 features per patient, four highest-ranking optimal features were derived (all texture-based features), which provided a classification accuracy of 0.80 with a sensitivity, specificity, and area under the receiver operating characteristic curve of 0.81, 0.81, and 0.87, respectively. CONCLUSION: A highly independent set of urinary bladder wall features derived from MRI scans were able to discriminate between patients with low vs. moderate-to-severe IPSS with accuracy of 80%. Such differences in MRI-based properties of the bladder wall in patients with varying IPSS's might reflect differences in underlying molecular and morphological alterations that occur in the setting of chronic bladder outlet obstruction.

Vesicourachal Diverticulum: An Uncommon Incidental Finding on Staging 18F-FDG PET/CT in a Patient with Suspected Malignant Transformation of Neurofibromatosis.

In a 32-y-old man with neurofibromatosis type 1, 18F-FDG PET/CT incidentally revealed a vesicourachal diverticulum, a rare anatomic variant. The PET/CT, performed for staging a malignant peripheral nerve sheath tumor, highlighted a distinctive 18F-FDG-avid pattern crucial for accurate diagnosis. Recognizing such features enhances disease assessment and clarifies distinctions between benign urogenital anomalies and malignancies in 18F-FDG PET/CT staging.

Preliminary Experience with Three Alternative Motion Sensors for 0.55 Tesla MR Imaging.

Due to limitations in current motion tracking technologies and increasing interest in alternative sensors for motion tracking both inside and outside the MRI system, in this study we share our preliminary experience with three alternative sensors utilizing diverse technologies and interactions with tissue to monitor motion of the body surface, respiratory-related motion of major organs, and non-respiratory motion of deep-seated organs. These consist of (1) a Pilot-Tone RF transmitter combined with deep learning algorithms for tracking liver motion, (2) a single-channel ultrasound transducer with deep learning for monitoring bladder motion, and (3) a 3D Time-of-Flight camera for observing the motion of the anterior torso surface. Additionally, we demonstrate the capability of these sensors to simultaneously capture motion data outside the MRI environment, which is particularly relevant for procedures like radiation therapy, where motion status could be related to previously characterized cyclical anatomical data. Our findings indicate that the ultrasound sensor can track motion in deep-seated organs (bladder) as well as respiratory-related motion. The Time-of-Flight camera offers ease of interpretation and performs well in detecting surface motion (respiration). The Pilot-Tone demonstrates efficacy in tracking bulk respiratory motion and motion of major organs (liver). Simultaneous use of all three sensors could provide complementary motion information outside the MRI bore, providing potential value for motion tracking during position-sensitive treatments such as radiation therapy.

Bladder trigone sparing radiotherapy in prostate cancer treatment.

INTRODUCTION: Evidence suggests the bladder trigone to be a potential organ at risk (OAR) in predicting acute and late genitourinary (GU) side effects when treating prostate cancer with radiotherapy. METHODS: A search of MEDLINE, Cinahl, EMBASE, PubMed, the Cochrane Database of Systematic Reviews and OpenGrey was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. A systematic literature review was carried out assessing the quality of this evidence. All evidence that prospectively or retrospectively reviewed radiotherapy or modelled radiotherapy dose to the bladder trigone were included. The search was conducted on the 8th July 2021 with 32 studies included in this review. This was repeated 10th June 2023 and two additional studies were identified. Any evidence published since this date have not been included and are a limitation of this review. RESULTS: MRI imaging is recommended to assist in delineating the trigone which has been shown to have a high amount of inter-observer variability and the use of specific training may reduce this. Across all radiotherapy treatment modalities, trigone dose contributed to GU acute and late toxicity symptoms. Trigone motion is relative to prostate motion but further research is required to confirm if the prostate can be used as a reliable surrogate for trigone position. The dose tolerance given for specific trigone related toxicities is debated within the literature, and on analysis the authors of this review suggest bladder trigone dose limits: Dmean < 45.8 Gy, V61.0Gy < 40%, V59.8Gy < 25%, V42.5Gy-V41.0Gy < 91% and V47.4Gy-V43.2Gy < 91% with α/ß of 3 Gy to reduce acute and late GU toxicities. CONCLUSION: There is evidence to support further research into bladder trigone sparing radiotherapy to improve patient outcomes. IMPLICATION FOR PRACTICE: Using the bladder trigone as an organ at risk is possible and the authors are currently seeking funding for a feasibility trial to further investigate this.

[Comparison of Bladder Volume Measurement Accuracy between Portable Ultrasound Diagnostic Equipment and CBCT for Pelvic Prostate Radiotherapy].

PURPOSE: We evaluated the measurement accuracy of the CubeScan BioCon-900 (here after BioCon-900), a portable ultrasound imaging diagnostic device capable of measuring bladder volume, to determine if it can accurately assess bladder volume before intensity-modulated radiation therapy (IMRT) for prostate cancer. METHODS: Bladder volume was measured from kV-Cone Beam computed tomography (CBCT) images obtained immediately before the administration of IMRT for prostate cancer using Halcyon. The bladder volume measured from kV-CBCT images (23 patients, total number of scans: 139) immediately before the IMRT procedure was used as the reference value. The difference between the bladder volume measured by the BioCon-900 was then calculated. RESULTS: The bladder volume measured from kV-CBCT images was 117.5±49.4 cc. In contrast, the bladder volume obtained with BioCon-900 was 104.1±48.6 ml, resulting in an absolute mean difference of 18.4% and a correlation coefficient of 0.881. The measurements by BioCon-900 tended to be, on average, 11% smaller than the bladder volume measured by kV-CBCT imaging. CONCLUSION: kV-CBCT images demonstrated a strong positive correlation between bladder volume and bladder urine output obtained with BioCon-900. BioCon-900 can be used before kV-CBCT imaging to accurately and conveniently assess bladder volume.

Cone beam CT doses in radiotherapy patient positioning in Finland-prostate treatments.

Imaging parameters, frequencies and resulting patient organ doses in treatments of prostate cancer were assessed in Finnish radiotherapy centres. Based on a questionnaire to the clinics, Monte Carlo method was used to estimate organ doses in International Commission on Radiological Protection standard phantom for prostate, bladder, rectum and femoral head. The results show that doses from cone beam computed tomography imaging have reduced compared to earlier studies and are between 3.6 and 34.5 mGy per image for the above-mentioned organs and for normal sized patients. There still is room for further optimization of the patient exposure, as many centres use the default imaging parameters, and the length of the imaged region may not be optimal for the purpose.

Return of voiding function after greenlight photovaporisation of the prostate for a patient with giant bladder.

Giant bladder is a rare condition with varied definitions and causes. It can lead to complications such as urinary tract infections, retrograde urine reflux, pyelonephritis, renal damage and occasionally vascular obstruction. In this case report, we present a man in his 70s with massive urinary retention >7 L and severe bilateral hydronephrosis. The patient underwent a successful Greenlight photovaporisation of the prostate to address underlying bladder outlet obstruction. The surgical procedure resulted in significant improvement in urinary function, enabling the patient to live catheter and infection free, and without renal damage. This case demonstrates that bladder outlet surgery can be useful in selected cases of giant bladder to avoid complications of chronic catheterisation or ongoing retention.

POP-Q Versus Upright MRI Distance Measurements: A Prospective Study in Patients with POP.

INTRODUCTION AND HYPOTHESIS: The gold standard for quantifying pelvic organ prolapse is the pelvic organ prolapse quantification (POP-Q) system; however, upright magnetic resonance imaging (MRI) is a promising new method. The objective of this study was to determine the correlation between POP-Q and MRI measurements of the bladder and cervix. METHODS: This prospective study included patients with prolapse in whom POP-Q points Aa or Ba and C were measured as standard care. MRI scans were performed in an upright position, and the distances of the lowest points of the bladder and cervix to the Pelvic Inclination Correction System (PICS) were calculated. Correlations between POP-Q and MRI-PICS measurements were determined using the Pearson correlation coefficient for normally distributed data and the Spearman's rank correlation coefficient for non-normally distributed data. RESULTS: A total of 63 patients were suitable for analysis. There was a moderate positive correlation between the POP-Q and MRI-PICS measurements for bladder (r(61) = 0.480, r < 0.001) and uterus (r(61) = 0.527, p < 0.001). Measurement differences between POP-Q and MRI-PICS of the bladder and uterus vary from -3.2 cm to 7.1 cm, and from -2.1 cm to 8.5 cm respectively. In 71.4% of patients more descent was seen on upright MRI than with POP-Q measurement for both bladder and uterus. For patients with similar POP-Q measurements, a high variation in MRI measurements of the bladder and uterus was found. CONCLUSION: Despite a moderate positive correlation, upright MRI shows a larger POP extent in 71.4% of the patients than POP-Q. A high variation in MRI measurements for patients with the same POP-Q measurement was seen.

Clinical study on improving the function of female bladder in controlling urine by acupuncture Zhibian (BL54) under ultrasound guidance.

OBJECTIVE: To observe the effect of acupuncture Zhibian (BL54) on the function of the bladder in controlling urine in women under ultrasound. METHOD: 74 healthy subjects were randomly divided into deep acupuncture group of 37 cases and shallow acupuncture group of 37 cases. Under the guidance of ultrasound, the two groups of subjects were acupunctured at bilateral BL54. The deep acupuncture group was acupunctured to the pudendal nerve, and the shallow acupuncture group was acupunctured to the superficial fascia. Ultrasound was used to observe the peak systolic velocity (PSV), time average maximum velocity (TAMX), end diastolic velocity (EDV), pulsation index (PI), resistance index (RI) of the pudendal arteries, and bladder volume of two groups of subjects before and after acupuncture. The anatomical hierarchical structure of bilateral BL54 and score of Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) of all subjects was measured. RESULT: After acupuncture, the PSV, TMAX of the pudendal artery, bladder volume, and the Score of C-MASS Scale in the deep acupuncture group were higher than in the shallow acupuncture group (P < 0.05). The RI of the pudendal arteries in the shallow acupuncture group decreased compared to before acupuncture (P < 0.05). CONCLUSION: Acupuncture at the BL54 can increase the blood flow velocity of the pudendal artery, improve the function of the bladder in controlling urine in women, and different depths of acupuncture will have different therapeutic effects.

Bladder MRI with deep learning-based reconstruction: a prospective evaluation of muscle invasiveness using VI-RADS.

PURPOSE: To investigate the influence of deep learning reconstruction (DLR) on bladder MRI, specifically examination time, image quality, and diagnostic performance of vesical imaging reporting and data system (VI-RADS) within a prospective clinical cohort. METHODS: Seventy participants with bladder cancer who underwent MRI between August 2022 and February 2023 with a protocol containing standard T2-weighted imaging (T2WIS), standard diffusion-weighted imaging (DWIS), fast T2WI with DLR (T2WIDL), and fast DWI with DLR (DWIDL) were enrolled in this prospective study. Imaging quality was evaluated by measuring signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and qualitative image quality scoring. Additionally, the apparent diffusion coefficient (ADC) of bladder lesions derived from DWIS and DWIDL was measured and VI-RADS scoring was performed. Paired t-test or paired Wilcoxon signed-rank test were performed to compare image quality score, SNR, CNR, and ADC between standard sequences and fast sequences with DLR. The diagnostic performance for VI-RADS was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Compared to T2WIS and DWIS, T2WIDL and DWIDL reduced the acquisition time from 5:57 min to 3:13 min and showed significantly higher SNR, CNR, qualitative image quality score of overall image quality, image sharpness, and lesion conspicuity. There were no significant differences in ADC and AUC of VI-RADS between standard sequences and fast sequences with DLR. CONCLUSIONS: The application of DLR to T2WI and DWI reduced examination time and significantly improved image quality, maintaining ADC and the diagnostic performance of VI-RADS for evaluating muscle invasion in bladder cancer.

Conception and implementation of an MRI-compatible device to elicit the bulbocavernosus reflex for an open spinal cord study.

OBJECTIVE: Functional MRI (fMRI) can be employed to assess neuronal activity in the central nervous system. However, investigating the spinal cord using fMRI poses several technical difficulties. Enhancing the fMRI signal intensity in the spinal cord can improve the visualization and analysis of different neural pathways, particularly those involved in bladder function. The bulbocavernosus reflex (BCR) is an excellent method for evaluating the integrity of the sacral spinal cord. Instead of stimulating the glans penis or clitoris, the BCR can be simulated comfortably by tapping the suprapubic region. In this study, we explain the necessity and development of a device to elicit the simulated BCR (sBCR) via suprapubic tapping while conducting an fMRI scan. METHODS: The device was successfully tested on a group of 20 healthy individuals. Two stimulation task block protocols were administered (empty vs. full bladder). Each block consisted of 40 s of suprapubic tapping followed by 40 s of rest, and the entire sequence was repeated four times. RESULTS: Our device can reliably and consistently elicit sBCR noninvasively as demonstrated by electromyographic recording of pelvic muscles and anal winking. Participants did note mild to moderate discomfort and urge to void during the full bladder task. CONCLUSION: Our device demonstrates an efficacious approach to elicit sBCR within an MRI bore to assess sacral spinal cord functional activity without generating any significant motion artifacts. SIGNIFICANCE: This device can explore the mechanisms and processes controlling urinary, digestive, or sexual function within this region in humans.

MRI evaluation of vesical imaging reporting and data system for bladder cancer after neoadjuvant chemotherapy.

BACKGROUND: The Vesical Imaging-Reporting and Data System (VI-RADS) has demonstrated effectiveness in predicting muscle invasion in bladder cancer before treatment. The urgent need currently is to evaluate the muscle invasion status after neoadjuvant chemotherapy (NAC) for bladder cancer. This study aims to ascertain the accuracy of VI-RADS in detecting muscle invasion post-NAC treatment and assess its diagnostic performance across readers with varying experience levels. METHODS: In this retrospective study, patients with muscle-invasive bladder cancer who underwent magnetic resonance imaging (MRI) after NAC from September 2015 to September 2018 were included. VI-RADS scores were independently assessed by five radiologists, consisting of three experienced in bladder MRI and two inexperienced radiologists. Comparison of VI-RADS scores was made with postoperative histopathological diagnosis. Receiver operating characteristic curve analysis (ROC) was used for evaluating diagnostic performance, calculating sensitivity, specificity, and area under ROC (AUC)). Interobserver agreement was assessed using the weighted kappa statistic. RESULTS: The final analysis included 46 patients (mean age: 61 years ± 9 [standard deviation]; age range: 39-70 years; 42 men). The pooled AUC for predicting muscle invasion was 0.945 (95% confidence interval (CI): 0.893-0.977) for experienced readers, and 0.910 (95% CI: 0.831-0.959) for inexperienced readers, and 0.932 (95% CI: 0.892-0.961) for all readers. At an optimal cut-off value ≥ 4, pooled sensitivity and specificity were 74.1% (range: 66.0-80.9%) and 94.1% (range: 88.6-97.7%) for experienced readers, and 63.9% (range: 59.6-68.1%) and 86.4% (range: 84.1-88.6%) for inexperienced readers. Interobserver agreement ranged from substantial to excellent between all readers (k = 0.79-0.92). CONCLUSIONS: VI-RADS accurately assesses muscle invasion in bladder cancer patients after NAC and exhibits good diagnostic performance across readers with different experience levels.

Comparison of estimations of urinary bladder volume in different scanning positions using 2D linear dimension formula and 3D bladder circumference tracing in client-owned cats.

Urinary bladder volume (UBV) can be estimated using point-of-care ultrasound. The purpose of this study was to compare 2 UBV estimation methods, i.e., three-dimensional (3D) bladder circumference tracing and 2-dimensional (2D) linear bladder dimension formula, against actual bladder volumes in awake client-owned cats and identify the best scanning position for UBV estimations. Up to 3 paired sets of orthogonal longitudinal and transverse bladder ultrasound images were acquired by a trained clinician from 21 cats positioned in dorsal, right lateral, and left lateral recumbency. UBV estimation was performed with these images by 2 different observers using both methods. Actual bladder volumes were measured through urethral catheterization and compared to the estimated UBV using Lin's concordance correlation coefficient and Bland-Altman analyses. Considering all positions, both methods showed substantial strength-of-agreement with actual bladder volumes; the 3D bladder circumference method (ρc = 0.963, 95% CI: 0.952 to 0.974) with a significant median bias of -4.08 mL (P < 0.001, IQR -7.63 to -0.68 mL, LOA -48.55 to 21.75 mL) and the 2D linear dimension method (ρc = 0.974, 95% CI: 0.966 to 0.982) with a median bias of -0.82 mL (P = 0.686, IQR -3.89 to 4.05 mL, LOA -35.23 to 35.21 mL). Scanning in left lateral recumbency provided the strongest strengths-of-agreement and precision against actual bladder volumes for both methods. Regardless of scanning positions, the 2D linear dimension method is more accurate than the 3D bladder circumference method, although both methods are imprecise with increasing volumes and UBV assessment through urinary catheterization remains the gold standard.

Le volume vésical (UBV) peut être estimé à l'aide de l'échographie au point d'intervention. L'objectif de cette étude fut de comparer 2 méthodes d'estimation du UBV, i.e., le tracé tridimensionnel (3D) de la circonférence de la vessie et la formule de dimension linéaire en 2 dimensions (2D), aux volumes vésicaux réels chez des chats éveillés appartenant à des clients, ainsi que d'identifier la meilleure position de balayage pour l'estimation du UBV. Jusqu'à 3 séries appariées d'images ultrasonores longitudinales et transverses orthogonales ont été acquises par une clinicienne qualifiée sur 21 chats positionnés en décubitus dorsal, latéral droit et latéral gauche. L'estimation du UBV a été réalisée à partir de ces images par 2 observateurs différents utilisant les 2 méthodes. Les volumes vésicaux réels ont été mesurés par cathétérisme urétral et comparés aux UBV estimés à l'aide du coefficient de corrélation de concordance de Lin et d'analyses de Bland-Altman. Toutes positions confondues, les 2 méthodes ont montré une concordance considérable avec les volumes vésicaux réels; la méthode de la circonférence vésicale 3D (ρc = 0,963, 95 % CI : 0,952 à 0,974) avec un biais médian significatif de −4,08 mL (P < 0,001, IQR −7,63 à −0,68 mL, LOA −48,55 à 21,75 mL) et la méthode de la dimension linéaire 2D (ρc = 0,974, 95 % CI : 0,966 à 0,982) avec un biais médian de −0,82 mL (P = 0,686, IQR −3,89 à 4,05 mL, LOA −35,23 à 35,21 mL). Le balayage en décubitus latéral gauche a démontré les meilleures concordance et précision par rapport aux volumes vésicaux réels pour les 2 méthodes. Quelle que soit la position de balayage, la méthode de la dimension linéaire 2D est plus précise que la méthode de circonférence vésicale 3D, bien que les 2 méthodes deviennent imprécises avec des volumes vésicaux plus élevés et que l'évaluation du UBV par cathétérisme urinaire demeure l'étalon d'or.(Traduit par les auteurs).

Point of Care Ultrasound Bladder Volume Calculation on the Acute Medical Unit.

Nursing staff, healthcare assistants (HCAs) and other healthcare professionals on the Acute Medical Unit (AMU) at Royal Berkshire Hospital (RBH) were taught a Point of Care Ultrasound (POCUS) skill during a twenty minute session. Practitioners learned how to take bladder volume measurements with the Butterfly iQ, a portable ultrasound device which provides a visually-aided method of volume measurement. A Likert scale was used to measure the confidence that staff had in performing volume measurements with the AMU automated scanners, and with the semi-automated Butterfly iQ. After the teaching session, confidence reported by practitioners in using the semi-automated visual method was significantly higher than confidence reported in using the automated non-visual scanners (t < 0.001). Minimal time and expense was required to teach practitioners how to perform this skill. Training nurses in POCUS for bladder visualisation and bladder volume calculation is easy and practicable.

Vaginal pessary: a culprit for intraperitoneal bladder perforation.

Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.

Pelvic floor muscle contraction automatic evaluation algorithm for pelvic floor muscle training biofeedback using self-performed ultrasound.

INTRODUCTION: Non-invasive biofeedback of pelvic floor muscle training (PFMT) is required for continuous training in home care. Therefore, we considered self-performed ultrasound (US) in adult women with a handheld US device applied to the bladder. However, US images are difficult to read and require assistance when using US at home. In this study, we aimed to develop an algorithm for the automatic evaluation of pelvic floor muscle (PFM) contraction using self-performed bladder US videos to verify whether it is possible to automatically determine PFM contraction from US videos. METHODS: Women aged ≥ 20 years were recruited from the outpatient Urology and Gynecology departments of a general hospital or through snowball sampling. The researcher supported the participants in their self-performed bladder US and videos were obtained several times during PFMT. The US videos obtained were used to develop an automatic evaluation algorithm. Supervised machine learning was then performed using expert PFM contraction classifications as ground truth data. Time-series features were generated from the x- and y-coordinate values of the bladder area including the bladder base. The final model was evaluated for accuracy, area under the curve (AUC), recall, precision, and F1. The contribution of each feature variable to the classification ability of the model was estimated. RESULTS: The 1144 videos obtained from 56 participants were analyzed. We split the data into training and test sets with 7894 time series features. A light gradient boosting machine model (Light GBM) was selected, and the final model resulted in an accuracy of 0.73, AUC = 0.91, recall = 0.66, precision = 0.73, and F1 = 0.73. Movement of the y-coordinate of the bladder base was shown as the most important. CONCLUSION: This study showed that automated classification of PFM contraction from self-performed US videos is possible with high accuracy.

Does volumetric measurement of ADC values achieve higher diagnostic performance in bladder cancer MRI?

BACKGROUND: Apparent diffusion coefficient (ADC) value is an important part of bladder cancer magnetic resonance imaging (MRI) assessment and can predict the aggressive and invasive potentials. There is growing interest in whole tumor volume measurements. PURPOSE: To investigate if the volumetric ADC measurement method will significantly exceed the diagnostic performance of the selected region of interest (ROI) method in everyday practice. MATERIAL AND METHODS: A prospective evaluation was carried out of 50 patients with bladder cancer by two radiologists. The mean and the minimum ADC values were measured using both methods. The inter-reader agreement was determined by the intraclass correlation coefficient. The ADC values were compared between different grades, states of muscle invasion, and lympho-vascular invasion (LVI); then, validity was evaluated using receiver operating characteristic (ROC) curves. Areas under the curve (AUC) were then compared for the level of statistical significance. RESULTS: The inter-observer agreement was excellent for the ADC values using both methods. The volumetric measurement provides higher mean and lower minimum ADC values with statistically significant differences (P <0.00001). The highest diagnostic accuracy for differentiating tumor grade and predicting muscle invasion was for the minimum ADC by a selected ROI. However, the differences between the achieved AUCs were of no statistical significance. None of the ADC values predicted LVI with statistical significance. CONCLUSION: The selected ROI and volumetric measurement methods of mean and minimum ADC in bladder cancer yield different values, still having comparable diagnostic performance with accurate ROI sampling. The minimum ADC value by ROI is preferred in everyday clinical practice.