Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement.

Background: Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective: The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods: This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results: The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion: Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

Impact of Bladder Wall Thickness on the Outcomes of Antimuscarinic Treatment in Women with Overactive Bladder.

AIM: This study aimed to evaluate the effect of bladder wall thickness (BWT) (using transabdominal ultrasound) on the outcomes of antimuscarinic treatment in women with overactive bladder. METHODS: A total of 102 female patients with symptoms of OAB were recruited. All patients completed the Overactive Bladder version 8 (OAB-V8) (Arabic validation) and the International Consultation of Incontinence Questionnaire (ICIQ-SF). Patients completed the urodynamic study (UDS) including uroflowmetry and PVR and measures of BWT by transabdominal ultrasound. The patients were classified into 2 major groups: G1 (patients with BWT <5 mm) and G2 (patients with BWT ≥5 mm). The patients were re-evaluated after 3-month medication with solifenacin 10-mg oral tablet. RESULTS: At baseline, the results of OAB-V8 and ICIQ-SF were significantly higher in G2 than G1 (p < 0.001). Regarding UDS, volume at 1st desire to void, volume at strong desire to void, and MBC were significantly higher in group 1 compared to group 2 (p = 0.001). Intravesical pressure at strong desire and patients' number of DO were significantly increased in G2 (p < 0.05 and p = 0.001, respectively). After treatment, there was an improvement in both groups regarding OAB-V8, ICIQ-SF, bladder volume at 1st desire to void, bladder volume at strong desire to void, bladder volume at DO, MBC, intravesical pressure at strong desire, and the patients' number with DO (decreased), and these improvements were statistically significant in group 1 compared to group 2 (p < 0.05). CONCLUSION: BWT showed a significant association with both OAB symptom scores and UDS parameters. The decrease in BWT is associated with a significantly higher response to solifenacin therapy regarding the UDS results.

Correlation of Urethral Ratio and Bladder Wall Thickness with Cystoscopic Findings in Posterior Urethral Valve Patients to Assess Residual Valves.

Introduction: Posterior urethral valve (PUV) is life threatening congenital anomaly of urinary tract. Aim of the study was to correlate urethral ratio (UR) and bladder wall thickness (BWT) with cystoscopic findings in PUV patients to assess residual valves and to validate UR as a diagnostic tool for residual valves. It also aimed to assess the utility of bladder wall thickness in diagnosis of residual valves. Materials and Methods: A total of 31 patients were included in the prospective study done from 2017 to 2019. Calculation of UR was done in oblique VCUG films by dividing maximum posterior and anterior urethral diameter without the catheter insitu. Measurement of BWT was done at dome and bladder neck at full distension with feeding tube insitu and was done at same volume in follow up. The procedure was repeated at 3 months follow up. The findings were compared with cystoscopic findings for the status of residual valves as gold standard. Each patient served as control for self in the study. Results: Median age of presentation was 1 years with range of 1day to 10 years. The most common complains at the time of presentation in our study was straining (35.48%) followed by antenatally diagnosed patients (25.81%) and recurrent UTI (19.36%). Pre fulguration median UR was 2.45. Post Fulguration median UR was 1.20. It showed a statistically significant reduction (p < 0.001) after fulguration. Pre fulguration median BWT was 4 mm. Post fulguration median BWT was 2.5 mm. BWT showed a statistically significant reduction (p < 0.001) after fulguration as well. ROC curve was plotted for UR and BWT. BWT more than 1.95 mm (sensitivity-80%) and UR more than 1.2 (sensitivity-70%) indicates residual valves. Conclusion: A step ladder approach including BWT, UR and check cystoscopy can serve as a new diagnostic algorithm for the assessment of residual valves thereby avoiding extra radiation and general anesthesia exposure.

The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram.

AIMS: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). METHODS: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2 O. A nomogram was developed based on the multivariable logistic regression model. RESULTS: Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. CONCLUSIONS: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS.

Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia.

BACKGROUND: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. OBJECTIVE: To study the relationship among BWT, PVR, and BEE in BPH. SUBJECTS AND METHODS: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. RESULTS: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). CONCLUSION: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.

Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease.

Background/aims: Esophageal varices (EV) are common complications in patients with advanced chronic liver disease (ACLD). Non-invasive parameters to exclude EV in patients with ACLD would be desirable. The aim of this study was the evaluation of liver stiffness measurement (LSM) using 2D-shear wave elastography (GE Logiq E9) and other non-invasive parameters as predictors for EV. Methods: Hundred patients with ACLD were enrolled. Abdominal sonography, including measurement of gall bladder wall thickness (GBWT), spleen diameter and LSM, gastroscopy and blood test results were evaluated. Statistical analyses were performed for the association between EV and non-invasive parameters. Results: Fifty-one per cent of the patients had EV. The mean LSM (14.6 kPa) and GBWT (3.88 mm) in the group with EV were significantly higher than in the group without EV (10.6 kPa; 2.94 mm; p < .01). Performing area under the receiver operating characteristic curve, LSM has a better diagnostic performance (0.781) than GBWT (0.707), spleen diameter (0.672) and platelet count (0.635). Combining LSM (cut-off 13.58 kPa) and GBWT (cut-off 3.07 mm) resulted in a sensitivity of 86.3% and a specificity of 71.4% for the presence of EV. A sensitivity of 100% (negative predictive value 1.0) was achieved at LSM >9 kPa or GBWT >4 mm. Following these criteria in our current study population, 18% of the gastroscopies could have been avoided. Conclusions: Combining LSM with non-invasive parameters, especially GBWT, improves the diagnostic accuracy for predicting EV. We suggest reconsidering screening gastroscopy in patients with ACLD who show LSM <9 kPa and GBWT <4 mm due to the very low risk of having varices.

Validation study of ultrasound bladder wall thickness measurements.

INTRODUCTION AND HYPOTHESIS: The aim was to validate ultrasound bladder wall thickness measurements. We scanned at three frequencies (5 MHz, 7 MHz and 9 MHz), using two techniques described in clinical practice and compared them with direct micrometre calliper measurements. METHODS: Bladder dome cadaver specimens were dissected from male and female cadavers. The direct micrometre calliper measurement under direct vision was used as the gold standard. We imaged using a Voluson E8 ultrasound scanner at three frequencies, using three probes: AB27D (2-7 MHz), RAB25D (2-5 MHz) and RIC50D (5-9 MHz). The specimens were scanned on two different occasions for intra-observer variability. A second operator, measured the samples again independently for the interobserver agreement. The specimens were gently placed onto a sheathed and gelled probe to avoid deformation. The method of scanning was the same for all the specimens, probes and operators. RESULTS: Twenty-five bladder dome specimens were assessed. The correlation of the ultrasound measurement to the direct measurement improved at higher ultrasound frequencies. Measuring from the inside of the serosal hyperechogenicity also increased the accuracy correlation with the direct measurement for all the frequencies tested. CONCLUSIONS: This is the first study validating BWT ultrasound measurements against cadaveric bladder wall calliper measurements. Technology and technique affect accuracy, which is important in clinical practice. The use of 5-MHz probes is not recommended. The most accurate measurement was obtained using high-frequency ultrasound, where the measurement did not include the serosal brightness. These data suggest that high-frequency ultrasound should be used to assess BWT.

Tolterodine ER reduced increased bladder wall thickness in women with overactive bladder. A randomized, placebo-controlled, double-blind, parallel group study.

AIMS: We evaluated the effect of Tolterodine extended release (TER) versus placebo on bladder wall thickness (BWT) using transvaginal ultrasound in women with overactive bladder (OAB). MATERIALS AND METHODS: We recruited 79 women with symptoms of OAB with a mean age of 47 years who had a BWT of at least 5 mm and a post-micturition volume of less than 50 mL at screening. Subjects received TER 4 mg or placebo once daily for the first 12 weeks of the study. For the subsequent 12 weeks, all subjects received TER 4 mg once daily. BWT was measured at screening, weeks 12 and 24. Subjects recorded number of micturitions, incontinence episodes and urgency episodes, and volume voided per micturition at regular intervals during the study. RESULTS: Treatment with TER for 12 weeks produced a statistically significant decrease from baseline in BWT (mean [SD] = 0.9 [1.4] mm; P < 0.05) that was not evident following treatment with placebo (0.2 [1.6] mm; P = 0.54). However, the treatment difference did not reach statistical significance (LS Mean = -0.4; 95%CI: -1.2, 0.3; P = 0.25). After 12 weeks of treatment, subjects who had taken TER showed an improvement in each bladder diary variable compared to placebo-treated subjects. CONCLUSIONS: TER may have a direct effect on BWT in women with OAB. Larger studies are warranted to further investigate the effect of behavioral interventions and antimuscarinics, such as TER, on BWT in women with OAB and increased BWT.

Correlation of bladder wall thickness and treatment success in types of urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. METHODS: In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients (N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. RESULTS: Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type (p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05 mm for SUI (sensitivity 74 %, specificity 66 %, positive predictive value [PPV] 85 %, negative predictive value [NPV] 50 %), 4.98 mm for DO (sensitivity 73 %, specificity 92 %, PPV 95 %, NPV 63 %) and 5.31 mm for mixed type (sensitivity 88 %, specificity 73 %, PPV 79 %, NPV 85 %). CONCLUSIONS: The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types.

Bladder wall thickness in women with symptoms of overactive bladder and detrusor overactivity: Results from the randomised, placebo-controlled shrink study.

AIMS: Measurement of bladder wall thickness (BWT) by transvaginal ultrasound (TVUS) may be a less invasive method to diagnose overactive bladder (OAB) or detrusor overactivity (DO) and monitor response to therapy. This study assessed whether treatment with solifenacin affects BWT. METHODS: This was a double-blind, randomised, placebo-controlled, phase 4 study. Adult women with OAB symptoms received solifenacin 5 or 10 mg or placebo once daily for 12 weeks. The co-primary endpoints were change from baseline to Week 12 in TVUS-measured BWT and urinary nerve growth factor. Only results for BWT are presented here. RESULTS: Overall, 547 patients were randomised, 501 patients had a baseline BWT measurement, and change from baseline could be calculated for 478 patients. Mean BWT at baseline was 5.08 mm (range 2.2-11.1, SD = 1.14) and was normally distributed. A significant reduction in BWT from baseline to 12 weeks versus placebo was observed with solifenacin 5 mg (-0.42 vs. -0.16 mm, P = 0.03), but not with the 10 mg dose or with pooled solifenacin, considered the primary comparison. Both solifenacin doses were associated with improvements in efficacy and patient satisfaction endpoints versus placebo. Solifenacin was well tolerated, with dry mouth being the most common adverse event. CONCLUSIONS: There was no consistent effect of solifenacin on BWT in women with OAB/DO, despite improvements in efficacy endpoints. This study suggests that routine clinical assessment of BWT with TVUS for monitoring the effects of OAB/DO treatment is not clinically useful. Neurourol. Urodynam. 35:819-825, 2016. © 2015 Wiley Periodicals, Inc.

Urinary NGF, TGF-ß1, TIMP-2 and bladder wall thickness predict neurourological findings in children with myelodysplasia.

PURPOSE: Dimercapto-succinic acid scintigraphy and urodynamic studies are gold standards to evaluate renal scarring and neurogenic bladder dysfunction, respectively. We sought to establish the value of bladder wall thickness together with urine NGF, TGF-ß1 and TIMP-2 to predict the urodynamic profile and upper urinary tract damage in children with myelodysplasia. MATERIALS AND METHODS: A total of 80 children with myelodysplasia underwent urodynamic investigation, bladder wall thickness measurement and dimercapto-succinic acid scintigraphy with basic neurourological evaluation. Two study and 2 control groups were created according to presence or absence of renal scarring on dimercapto-succinic acid scan (study and control groups 1) and according to detrusor leak point pressure greater or less than 40 cm H2O (study and control groups 2). Urine samples were analyzed with ELISA. RESULTS: The study population consisted of 44 girls and 36 boys with a median ± SD age of 7.2 ± 3.6 years (range 2 to 17). Study and control groups 1 consisted of 35 and 45 children with abnormal and normal dimercapto-succinic acid scan findings, respectively. Study and control groups 2 included 30 and 50 children with detrusor leak point pressure greater and less than 40 cm H2O, respectively. Bladder wall thickness and urinary levels of TGF-ß1, NGF and TIMP-2 were significantly increased in both study groups compared to controls. CONCLUSIONS: Urine markers and bladder wall thickness measurement may predict urinary tract impairment in children with myelodysplasia. Such markers may differentiate at risk patients with either renal scarring or high detrusor leak point pressure, and decrease the need for urodynamics and renal scintigraphy.

Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction.

BACKGROUND: Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. OBJECTIVE: To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. STUDY DESIGN: In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. RESULTS: The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45 ± 4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p = 0.049, r = -0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58 ± 0.68 mm in the NC group and 2.18 ± 1.35 mm in the LC group (p = 0.044). Left lateral wall thickness was 1.45 ± 0.44 mm in the NC group and 2.02 ± 1.4 mm in the LC group (p = 0.033). DISCUSSION: Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. CONCLUSION: Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.

Bladder wall thickness and ultrasound estimated bladder weight in healthy adults with portative ultrasound device.

BACKGROUND: The aim of this study was to investigate bladder wall thickness (BWT) and ultrasound estimated bladder weight (UEBW) values in healthy population with a portative ultrasound device and their relationship with demographic parameters. MATERIALS AND METHODS: The study was carried out in Neurorehabilitation Clinic of Ege University Hospital. Ninety-five subjects (48 women and 47 men) aged between 18 and 56 were included in the study. BWT and UEBW were determined non-invasively with a portative ultrasound device; Bladder Scan BVM 6500 (Verathon Inc., WA, USA) at a frequency of 3.7 MHz at functional bladder capacity. These values were compared by gender, and their relation was assessed with age, body mass index (BMI) and parity. RESULTS: Mean BWT was 2.0 ± 0.4 mm and UEBW was 44.6 ± 8.3 g at a mean volume of 338.0 ± 82.1 ml. Although higher results were obtained in men at higher bladder volumes, the results did not differ significantly by gender. Correlation analyses revealed statistically significant correlation between UEBW and age (r = 0.32). BWT was negatively correlated with volume (r = -0.50) and bladder surface area (r = -0.57). Also, statistically significant correlations were observed between UEBW and volume (r = 0.36), bladder surface area (r = 0.48) and BWT (r = 0.25). CONCLUSION: Determined values of BWT and UEBW in healthy population are estimated with portative ultrasound devices, which are future promising, for their convenient, easy, non-invasive, time-efficient hand-held use for screening.

Bladder wall thickness measured by CT can predict bladder outlet obstruction in men: a retrospective cohort study.

PURPOSE: To evaluate whether bladder wall thickness (BWT) measured by CT can be used to predict bladder outlet obstruction in men with low urinary tract symptoms (LUTS). METHODS: From 2015 to 2018, a total of 120 men with lower urinary tract symptoms who underwent both urodynamic studies and CT tests of the lower abdomen or pelvis were involved. Bladder wall thickness values were measured by CT scanning. RESULTS: Based on the urodynamic studies, 120 men were categorized into two groups, including 70/120 men (58.3%) in the bladder outlet obstruction (BOO) group and 50/120 men (41.7%) in the non-BOO group. The mean BWT was thicker in the BOO group than in the non-BOO group (3.87 vs. 2.75 mm, p < 0.001). The mean maximum bladder capacity (MBC) was lower in the BOO group than in the non-BOO group (263.42 vs. 308.96 ml, p < 0.001). The mean detrusor pressure at maximum urinary flow rate (PdetQmax) was higher in the patients in the BOO group than in those in the non-BOO group (102.28 vs. 49.25 cmH2O, p < 0.001). The ROC curve showed that BWT was a good predictor with an AUC of 0.855 (95% CI 0.785-0.924, p < 0.001). At the cutoff value of 3.20 mm, the predictive sensitivity of BWT for BOO was 72.9%, and the specificity was 90%. CONCLUSION: Increased bladder wall thickness was correlated with bladder outlet obstruction in men with LUTS. Bladder wall thickness measured by CT scans may be a noninvasive parameter to predict bladder outlet obstruction in men with LUTS.

Urinary bladder wall thickness in type 2 diabetes mellitus patients.

Introduction: Diabetes mellitus is an increasing health challenge with accompanying urological complications. Over 50% of men and women with diabetes have bladder dysfunction. According to the current understanding of bladder dysfunction, it refers to a progressive condition encompassing a broad spectrum of lower urinary tract symptoms including urinary urgency, frequency, nocturia, and incontinence. Urinary bladder dysfunction has been classically described as diminished bladder sensation, poor contractility, and increased post-void residual urine, termed bladder cystopathy. Ultrasonography of the urinary bladder, which is a cheap, safe, radiation free, non-invasive and reliable imaging modality, may help to identify diabetes mellitus patients prone to develop urinary bladder dysfunction. Method: The study population comprised 80 diabetic subjects recruited from the diabetic outpatient clinic and another 80 age- and sex-matched asymptomatic control subjects. Ultrasound scan of their urinary bladder wall was performed using a curvilinear transducer to determine the thickness and other sonographic features. Results: Out of the 80 diabetic subjects, 30 (37.5%) were males, while 50 (62.5%) were females; of 80 non-diabetic control subjects, 40 (50%) were males and 40 (50%) were females. The mean age of the diabetic subjects was 59.5 ± 10.4 years with a range of 40-82 years, while that of the controls was 60.2 ± 7.4 years with a range of 40-85 years. There was no statistically significant difference (p = 0.637) between the mean age of the diabetic and control subjects. The mean urinary bladder wall thickness in the diabetics was greater than in the non-diabetics in the study subjects. There was a statistically significant difference between the urinary bladder thickness of diabetic subjects and the control group (p <0.001). The mean urinary bladder wall thickness of the male and female subjects included in this study was 2.84 ± 1.31 mm and 2.9 ± 1.37 mm, respectively, with no statistically significant difference between them (p = 0.159). It was statistically significant between diabetic men and women (p = 0.027). Using Spearman's rank correlation to test the relationship between the glycaemic haemoglobin level of diabetic subjects and urinary bladder wall thickness, it was revealed that there was no correlation between these variables (Spearman's rho = 0.119, p = 0.309). The relationship between the urinary bladder volume of diabetic subjects and their mean urinary bladder wall thickness showed no correlation either (Spearman's rho = -0.009, p = 0.937). Only gender was a statistically significant predictor of urinary bladder wall thickness among other variables. Conclusion: Mean bladder wall thickness in patients with type 2 diabetes mellitus was greater than in the control subjects, and also greater in diabetic men compared to diabetic women, but the difference did not attain statistical significance. Urinary bladder wall thickness of the diabetics did not correlate with their glycaemic haemoglobin levels. Only gender was found to be a predictor of bladder wall thickness.

Can ultrasound measurement of bladder wall thickness be a useful adjunct for regular urodynamics in children with spina bifida?

INTRODUCTION: Spina bifida is a major cause of neurologic bladder dysfunction among children. The goal of neurogenic bladder treatment is to preserve renal function. Close follow-up is essential, as lower urinary tract functions can change with patient growth. Presently, invasive urodynamics is the gold standard for precisely assessing lower urinary tract function. Ultrasound is a low-cost, non-invasive, uncomplicated examination that can be easily repeated. Bladder wall thickness (BWT) measurement by ultrasound has been proposed as a non-invasive alternative for identifying lower urinary tract dysfunctions. OBJECTIVE: Currently there are few reports on BWT in children with spina bifida, and BWT assessment methodology has yet to be defined. The present study aim was to investigate whether BWT could be a useful adjunct for regular urodynamics in children with spina bifida. We especially focused on the precise bladder volume during BWT measurements that were simultaneously performed with urodynamics. STUDY DESIGN: This prospective observational study investigated 33 patients with spina bifida who underwent video urodynamics. We assessed BWT measurements using ultrasound simultaneously performed with video urodynamics. BWT was calculated for the ventral and dorsal walls at 0%, 20%, 40%, 60%, 80%, and 100% of the expected bladder capacity. RESULTS: Median of bladder capacity was 240 mL, and bladder compliance was 19.2 mL/cmH2O. Detrusor overactivity was present in 66.7% and vesicoureteral reflux was present in 27.3% of the patients. BWT of the ventral wall was significantly lower than the dorsal wall. During increases in the bladder volume, both the ventral and dorsal walls exhibited proportional thinning (p < 0.05). There were no significant differences for BWT between males and females. Although there was a higher statistical tendency for detrusor overactivity versus without detrusor overactivity (p = 0.085), there were no significant differences found between patients with and without detrusor overactivity. DISCUSSION: This is the first report where multiple BWT measurements points with video urodynamics were simultaneously performed. Selection of bladder volumes for BWT measurements is critical. Our current study measured six points for each patient during urodynamics. However, available data was not sufficient for detecting bladder function. Until now, there has been no valid standard condition defined for measuring BWT and thus, lack of a standardized method has resulted in discrepancies among studies. CONCLUSION: Our measurement conditions showed BWT may not correlate with the degree of bladder detrusor dysfunction. As BWT ultrasound cannot identify bladder dysfunction of children with spina bifida, this cannot be used as a substitute for invasive urodynamics.

Presurgical bladder wall thickness is a useful marker to predict the postsurgical improvement of symptoms in patients with pelvic organ prolapse-related overactive bladder.

OBJECTIVES: Pelvic organ prolapse (POP) is a cause of overactive bladder (OAB), and transvaginal mesh (TVM) surgery can improve the symptoms. Bladder wall thickness (BWT) is a useful and safe marker to evaluate bladder function in urinary disorders. The main purpose of this study is to clarify the relationship between BWT and changes in the OAB symptom score (OABSS) after TVM operation in patients with POP. METHODS: BWT was measured by ultrasonography before and 6 months after surgery at three sites in the bladder: the anterior wall, trigone, and dome. Similarly, the OABSS was evaluated at the time of BWT measurement. Changes induced in BWT at each site and the mean BWT at all sites after TVM surgery were analyzed. Similarly, the relationship between presurgical BWT and the decrease in OABSS was investigated. RESULTS: TVM surgery improved OABSS in 30 patients (responders; 73.2%), while 11 patients were judged as nonresponders (26.8%). BWT at the anterior bladder wall and dome as well as the mean BWT at all three sites were significantly decreased by TVM surgery (P < .001). Similar trends were identified in OABSS responders; however, all markers showed no significant changes in OABSS nonresponders. All the BWT-related markers before surgery were significantly lower in OABSS responders than in OABSS nonresponders. CONCLUSIONS: BWT at the bladder anterior wall and dome, but not the trigone, were decreased by TVM surgery. We conclude that presurgical BWT may be a useful marker to predict the improvement in OAB symptoms by TVM surgery in patients with POP-related OAB.

A non-invasive ultrasound imaging method to measure acute radiation-induced bladder wall thickening in rats.

BACKGROUND: Methods for the non-invasive quantification of changes in bladder wall thickness as potential predictors of radiation cystitis in pre-clinical research would be desirable. The use of ultrasound for this aim seems promising, but is still relatively unexplored. A method using ultrasound for bladder wall thickness quantification in rats was developed and applied to measure early radiation-induced bladder wall thickness changes. METHODS: Two groups (n = 9 each) of female Fischer rats were treated with a single radiation dose of 25-30 and 35-40 Gy respectively, using an image-guided micro-irradiator; six untreated rats were monitored as a control group. Empty, half-filled and fully-filled bladder volumes were determined for four non-irradiated rats by measuring axes from ultrasound 3D-images and applying the ellipsoid formula. Mean bladder wall thickness was estimated for both ventral and dorsal bladder sides through the measurement of the bladder wall area along a segment of 4 mm in the central sagittal scan, in order to minimize operator-dependence on the measurement position. Ultrasound acquisitions of all fully-filled rat bladders were also acquired immediately before, and 4 and 28 days after irradiation. Mean bladder wall thickness normalized to the baseline value and corrected for filling were then used to evaluate acute bladder wall thickening and to quantify the dose-effect. RESULTS: The relationship between mean bladder wall thickness and volume in unirradiated rats showed that for a bladder volume > 1.5 mL the bladder wall thickness is almost constant and equal to 0.30 mm with variations within ± 15%. The average ratios between post and pre irradiation showed a dose-effect relationship. Bladder wall thickening was observed for the 25-30 Gy and 35-40 Gy groups in 2/9 (22%) and 5/9 (56%) cases at day 4 and in 4/9 (44%) and 8/9 (89%) cases at day 28, respectively. The two groups showed significantly different bladder wall thickness both relative to the control group (p < 0.0001) and between them (p = 0.022). The bladder wall thickness increment was on average 1.32 ± 0.41, and was 1.30 ± 0.21 after 25-30 Gy and 1.47 ± 0.29 and 1.90 ± 0.83 after 35-40 Gy at days 4 and 28 respectively. CONCLUSIONS: The feasibility of using ultrasound on a preclinical rat model to detect bladder wall thickness changes after bladder irradiation was demonstrated, and a clear dose-effect relationship was quantified. Although preliminary, these results are promising in addressing the potential role of this non-invasive approach in quantifying radiation cystitis.

Gall Bladder Wall Thickening in Dengue Fever - Aid in Labelling Dengue Hemorrhagic Fever and a Marker of Severity.

Introduction Dengue fever is a mosquito-borne viral disease spread by the bite of the Aedes aegypti mosquito. Dengue epidemics have contributed to a great economic burden, especially in South-East Asia. This study aimed to determine gall bladder wall thickness (GBWT) in patients with dengue fever, assess its sensitivity and specificity to identify dengue hemorrhagic fever, and also compare gall bladder wall thickening (GWBT) with platelets, hematocrit, and leucocyte count. Materials and methods This prospective observational study was conducted in the dengue ward of Benazir Bhutto Hospital, Rawalpindi, Pakistan, from September 2019 to January 2020, i.e., four months. Patients admitted to the dengue ward diagnosed as seropositive and provided consent were enrolled into the study. Laboratory investigations (blood complete picture, liver function tests, renal function tests) were collected and recorded. Ultrasonography was performed on admission and subsequently during a hospital stay. Patients were divided into two groups: those with gall bladder wall thickness ≤ 3mm and Ëƒ3mm. All data were entered and analyzed on SPSS version 24 (IBM Inc., Armonk, USA). Results Out of 180 patients, 122 (67.8%) were male, and 58 (32.2%) female. The mean age was 33 ± 13 years. One hundred and six patients (58.9%) were diagnosed with dengue fever, 68 (37.8%) - dengue hemorrhagic fever, and six (3.3%) - dengue shock syndrome. The most common finding was gall bladder wall thickness ˃3mm (69/180; 38.3%) followed by ascites (38.1%). Sixty-two patients out of 69 (89.9%) with GBWT ˃3mm were managed as dengue hemorrhagic fever (p=0.000). Alanine transaminase (ALT), platelet, and total leukocyte count (TLC) were associated positively with an edematous gall bladder wall (p<0.005). The mean gall bladder wall thickness for dengue hemorrhagic fever was 6.4mm ± 2.5 mm. A GBWT value of 3.5mm was found to have 94.6% specificity and 91.2% sensitivity. Conclusion Gall bladder wall edema is strongly correlated with dengue hemorrhagic fever. Hence it should be assessed in all patients with dengue fever.

Interrater reliability of bladder ultrasound measurements in children.

INTRODUCTION: Bladder ultrasound is becoming pivotal in the management and treatment of lower urinary tract dysfunction. There is a paucity of data regarding intra-observer and interobserver reliability of bladder ultrasound, especially in children. A previous study assessed interobserver agreement for both the postvoid residual volume and measurement of the bladder dimensions in adults showing excellent agreement. OBJECTIVE: To examine the interobserver and intra-observer reliability of bladder wall thickness, bladder urinary and postvoid residual urinary volume using ultrasound evaluated by paediatricians having different training levels. STUDY DESIGN: Four sonographers, 3 pediatric trainees and one experienced pediatric urologist measured the full bladder volume, the voiding residual volume, and the bladder wall thickness. Each sonographer made 3 measurements of each parameter. We assessed the interobserver and intra-observer variability by using intraclass correlations (ICCs). ICCs were calculated and tested with a significance level of 5%. The interrater ICC was calculated from the mean of the three measurements of each variable (full bladder volume, postvoid residual, bladder wall thickness). ICC ≥0.75 was considered excellent. Bland-Altman plots were also used to assess the interobserver agreement. RESULTS: Sixty children were recruited (7.3 ± 1.1 years). The interobserver ICCs for bladder volume and voiding residual volume were 0.91 (confidence interval 0.85-0.95) for both. The interobserver ICCs for the bladder wall thickness was satisfactory 0.43, with a minimum detectable difference of 2 mm. The observed values for intra-observer analysis showed an excellent (ICC ≥ 0.90) agreement between the three measurements performed by each one of the sonographers. Bland-Altman plots showed that the bias (mean difference) was -0.35 and the limits of agreement were -3.43 and 2.73 for the bladder wall thickness measurements (Figure). DISCUSSION: The interobserver reliability for both the postvoid residual volume and full bladder volume were excellent even in operators with different levels of training, pointing out the role of bladder ultrasound in the routine clinical practice. Weaker agreement was found for the bladder wall thickness measurement. The intra-observer agreement was excellent for all the measurements. CONCLUSION: These results showed a good reliability of urinary bladder ultrasound in children aged 7.3 ± 1.1 years as far as bladder volume measurement is concerned. Given the variability of bladder wall thickness, a standardized methodology is desirable to increase its reliability.