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      Comparison of 2D and 3D ultrasound methods to measure serial bladder volumes during filling: Steps toward development of non-invasive ultrasound urodynamics

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          Abstract

          OBJECTIVES

          Non-invasive methods to objectively characterize overactive bladder (OAB) and other forms of voiding dysfunction using real-time ultrasound are currently under development but require accurate and precise serial measurements of bladder volumes during filling. This study’s objective was to determine the most accurate and precise ultrasound-based method of quantifying serial bladder volumes during urodynamics (UD).

          METHODS

          Twelve female participants with OAB completed an extended UD procedure with the addition of serial bladder ultrasound images captured once per minute. Bladder volume was measured using three ultrasound methods: (1) V spheroid: two-dimensional (2D) method calculated assuming spheroid geometry; (2) V bih: 2D correction method obtained by multiplying V spheroid by a previously derived correction factor of 1.375; and (3) V 3D: three-dimensional (3D) method obtained by manually tracing the bladder outline in six planes automatically reconstructed into a solid rendered volume. These volumes were compared to a control (V control) obtained by adding UD infused volume and the volume of estimated urine production.

          RESULTS

          Based on linear regression analysis, both V bih and V 3D were fairly accurate estimators of V control, but V 3D was more precise. V spheroid significantly underestimated V control.

          CONCLUSIONS

          Although the V bih and V 3D methods were more accurate than the more-commonly used V spheroid method for measuring bladder volumes during UD, the V 3D method was the most precise and could best account for non-uniform bladder geometries. Therefore, the V 3D method may represent the best tool required for the continued development of non-invasive methods to diagnose OAB and other forms of voiding dysfunction.

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          Most cited references33

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          Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition.

          Urinary incontinence and other lower urinary tract symptoms exert a major influence on the health and independence of frail older people. Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. DU may influence the clinical presentation and impede the therapy of disorders as common and as disparate as detrusor overactivity, urinary retention, and benign prostatic hyperplasia. Urodynamically, nearly two-thirds of incontinent nursing home residents exhibit DU. The clinical diagnosis of DU when present alone or in association with other bladder conditions such as detrusor overactivity (detrusor hyperactivity with impaired contractility (DHIC)) is challenging, because symptoms lack adequate precision. A catheterized and increasingly noninvasive ultrasound-based postvoid residual assessment allows a bedside diagnosis of retention and may suggest the presence of DU in individuals (mostly women) with a low likelihood of bladder outlet obstruction (BOO). Nevertheless, it cannot differentiate primary DU from retention secondary to BOO. The management of individuals with DHIC remains unsatisfactory, because antispasmodic anticholinergic medications may worsen retention, whereas bethanechol does not improve bladder emptying. Human detrusor biopsies reveal axonal degeneration, muscle loss, and fibrosis in DU. Animal studies suggest that multiple risk factors, including retention itself, lack of estrogen, infection, inflammation, and aging, may contribute to DU. Priority areas for future research include efforts to facilitate clinical nonurodynamic diagnosis of probable DU plus translational research designed to address the pathogenesis of this complex multifactorial geriatric syndrome.
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            Urinary retention and post-void residual urine in men: separating truth from tradition.

            The definitions of acute and chronic urinary retention remain empirical and subject to wide interpretation. Standardized criteria have not been established and many questions remain unanswered. Moreover, the definition of significant post-void residual urine is unclear. We reviewed several aspects of urinary retention that require clarification with the objective of stimulating discussion among urologists to establish an accurate and coherent definition of urinary retention and significant post-void residual urine, and clarify risk factors. A MEDLINE search for articles written in English and published before April 2007 was done using a list of terms related to urinary retention. Articles not directly relevant to urinary retention or post-void residual urine were excluded. The term urinary retention lacks precise clinical or urodynamic meaning. Use of this term to describe a symptom, a sign, and a condition further complicates the issue. Many factors can contribute to the development of retention, including bladder outlet obstruction, detrusor underactivity, and neurogenic bladder conditions. Community based studies and clinical trials in patients with benign prostatic enlargement and/or lower urinary tract symptoms yield different estimates of the incidence of retention and only provide information on the epidemiology of acute urinary retention. However, age, previous retention episodes, lower urinary tract symptoms, chronic inflammation, serum prostate specific antigen level, prostate size, and urodynamic variables appear to be predictors of acute urinary retention. Alpha-receptor antagonists and 5alpha-reductase inhibitors may be useful in preventing urinary retention episodes and progressive benign prostatic enlargement. Clinical trials on the short-term use of antimuscarinics have not provided evidence that these agents increase the risk of retention; data on longer term administration are needed. Clinicians are adopting less invasive approaches (eg pharmacology or catheterization) to treating patients who present with the symptoms, sign, and condition of urinary retention. Faced with an abundance of new data on acute urinary retention, urologists need to reach a consensus about the risks of urinary retention; this may promote movement toward patient centered prevention strategies with tailored treatment options.
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              International Continence Society guidelines on urodynamic equipment performance.

              These guidelines provide benchmarks for the performance of urodynamic equipment, and have been developed by the International Continence Society to assist purchasing decisions, design requirements, and performance checks. The guidelines suggest ranges of specification for uroflowmetry, volume, pressure, and EMG measurement, along with recommendations for user interfaces and performance tests. Factors affecting measurement relating to the different technologies used are also described. Summary tables of essential and desirable features are included for ease of reference. It is emphasized that these guidelines can only contribute to good urodynamics if equipment is used properly, in accordance with good practice.
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                Author and article information

                Journal
                101664418
                44161
                Bladder (San Franc)
                Bladder (San Franc)
                Bladder
                2327-2120
                10 January 2018
                4 January 2018
                2018
                17 January 2018
                : 5
                : 1
                : e32
                Affiliations
                [1 ]Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
                [2 ]Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
                [3 ]Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
                [4 ]Department of Surgery/Division of Urology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
                Author notes
                [* ]Corresponding author: John E. Speich, jespeich@ 123456vcu.edu
                Article
                NIHMS932827
                10.14440/bladder.2018.565
                5771657
                29354653
                9dee1e87-bfdf-4ed1-9588-d5049285962a

                This work is licensed under a Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 International License: http://creativecommons.org/licenses/by-nc-sa/4.0

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                Categories
                Article

                overactive bladder,transabdominal ultrasound imaging,urodynamics,volume calculations,volumetric ultrasound

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