Capacity of the unused bladder in end stage renal disease.

OBJECTIVES: To evaluate the bladder capacity in patients diagnosed with end stage renal disease (ESRD). MATERIAL AND METHOD: A six-month prospective study was conducted at the outpatient X-ray unit, Department of Radiology, King Chulalongkorn Memorial Hospital from July 2002 to January 2003. Datas from adult patients sent to the unit for voiding cystourethrography (VCUG) were collected. Bladder capacity was obtained by calculating the amount of contrast material introduced into the urinary bladder in each VCUG. The urinary bladder was assumed to be at the maximum capacity when the patient had a strong desire to void during contrast instillation. Patients with voiding dysfunction or neurogenic bladder were excluded from the present study. RESULTS: There were 11 patients with ESRD (male=7, female=4, mean age=41 years) and 7 patients without ESRD (male=1, female=6, mean age=41 years). The maximum bladder capacity was 400 ml for the ESRD patients and 500 ml for the non-ESRD patients. The smallest bladder capacity was 100 ml for the ESRD patients and 250 ml for the non-ESRD patients. The mean bladder capacity was 254.5 ml (+/-SD) for the patients with ESRD and was 364.28 ml for the patients without ESRD. The P-value was 0.043. In conclusion, the mean bladder capcity of the patients with ESRD was statistically smaller than that of patients without ESRD.

Extravasation of the contrast in the unused urinary bladder.

Ruptured bladder or extravasation from the bladder is almost always associated with trauma. Spontaneous extravasation is extremely rare with only a few reported cases. All those reported extravasations occurred in the patients diagnosed with end stage renal disease (ESRD) and were self limiting conditions. During the one-year period of 2001, voiding cystourethrography (VCUG) of 115 patients were performed in our institution with various indications. The authors found 3 cases with extravasation of contrast from the bladder during VCUG. All extravasations were occurred in ESRD patients and the VCUG was performed as part of the routine investigation prior to renal transplantation. The presented cases shared a similar observation of 1) no traumatic catheterization, 2) only minimal and self limiting extravasation and 3) no immediate or delayed symptom associated with extravasation. The cause and mechanism of leakage remain uncertain. Hypertonicity and mucosal changes within the unused bladder were purposed as probably the two main causes of extravasation.

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.