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Introduction: The gold standard for diagnosing bladderoutlet obstruction is pressure flow study but it is associatedwith side effects of high cost, invasiveness, infection, limitedavailability. So non invasive diagnostic tests becomes a goodoption. The diagnostic accuracy of these non invasive tests,however, remains uncertain. So this study was conductedto know the role of non invasive diagnostic tests likeInternational prostate symptom score (IPSS), Uroflowmetry(UFR), prostate volume, bladder wall thickness, post voidresidual urine in symptomatic patients with BPH in theirevaluation and in the planning of management.Material and methods: The present study included 108 malepatients above 50 years suffering from symptomatic BPH whoattended urology OPD at SVIMS, Tirupati. IPSS, Urinaryflow rates, bladder wall thickness, prostate volume, post voidresidual urine and urodynamic study have been recorded inthese patients at the time of enrollment into study.Results: One hundred and eight men between 50 – 79 years ofage with mean age of 62.4 years participated in this study. Allthe patients were divided into two groups as either obstructedor un obstructed based on Abraham – Griffith numbercalculated from the urodynamic study. Bladder wall thickness,Q max, Post void residual urine and prostate volume allhad statistically significant values between obstructed andun obstructed patients. However, there was no statisticalsignificant differences between age, IPSS in both the groupsConclusion: This study shows that in a subset of patientswith BPH with predefined inclusion and exclusion criteria,it should be possible to define obstruction with simple noninvasive parameters, without using invasive pressure flowstudy
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Objective To investigate correlation between bladder wall thickness (BWT) and upper urinary tract damage (UTD) in patients with neurogenic lower urinary tract dysfunction (NLUTD),and to evaluate the value of BWT in predicting UTD.Methods To retrospectively analyze clinical data of NLTUDpatients admitted from January 2013 to October 2017.Of the 161 patients,92 were male and 69 were female.The mean age was (39.5 ± 18.4) years old,ranged from 18 to 81 years old.83 cases had hydronephrosis,64 cases had unilateral or bilateral ureteral dilation and 14 cases had ureteral reflux.In 30 cases,the serum creatinine was abnormal (290.7 ± 164.0) μmol/L,ranging 125-938 pmol/L.The mean GFR in 17 cases was(45.2 ± 23.0) ml/(min · 1.73 m2),ranged from 84.3 to 14.6 mL/ (min · 1.73 me).According to the presence or absence of UTD,NLUTD patients were divided into experimental group and control group,101 cases of UTD combined experimental group,and 60 cases of UTD-free control group.There were 60 male patients and 41 female patients in the experimental group with mean age of (37.9 ± 19.1) years old.In the control group,there were 32 male patients and 28 female patients with mean age of (42.3 ± 16.8) years old,There was no statistical difference between the two groups (P ＞ 0.05).There were 59 cases and 5 cases of hydronephrosis in the experimental group and the control group,respectively.There were 12 cases and 2 cases of ureteral dilation patients in the experimental group and the control group,respectively.The differences in BWT and urodynamic parameters between the two groups were compared.The ROC curve was used to determine the cutoff value of BWT in the diagnosis of UTD and the correlation between BWT and UTD and urodynamic parameters was analyzed.Results 161 patients had a BWT of 2 to 25 mm with a median value of 7.0 (7.1) mm.119 patients underwent urodynamic examination with bladder compliance of 0.8 to 141.5 ml/cmH2O,median value of 12.7 (22.8) ml/cmH2O.The median value of median pressure capacity (MCC) was 256 (171) ml,ranged from 49 to 700 ml.The median value of Pdetmax was34 (19.1)cmH2O,ranged from 3 to 144 cmH2O.The median BWT values of the test and control groups were 9.0 (5.0) mm and 4.0 (5.7) mm,respectively (Z =-5.931,P ＜ 0.001).The median bladder compliance was 9.3 (15.3) ml/cmH2O and 24.2 (38.7) ml/cmH2 O,respectively (Z =-4.07,P ＜ 0.05).The MCC was 225.0 (159.0) ml and 310.6 (140.5) ml,respectively (Z =-2.22,P ＜ 0.05).The median Pdetmax during filling was 40.0 (20.4) emH2 O and 29.2 (18.4) cmH2 O,respectively (Z =-2.92,P ＜ 0.05).Using multivariate correlation analysis,BWT was negatively correlated with bladder compliance (r =-0.419,P ＜0.001) and negatively correlated with maximum bladder pressure capacity (r =-0.198,P =0.031),with the largest filling period.Pdetmax was positively correlated (r =0.251,P =0.006).Using the ROC curve to determine the threshold,the sensitivity of the UTD is 86.1％ and the specificity is 53.3％ when BWT≥4.8 mm.Conclusions BWT thickening is one of the risk factors for UTD in patients with NLUTD.When BWT is greater than 4.8 mm,NLUTD patients are more likely to have UTD and can be used as an examination method for the diagnosis of UTD in NLUTD patients.
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OBJECTIVE: To investigate the correlation between bladder wall thickness (BWT) measured by ultrasonography and lower urinary tract dysfunction (LUTD) in patients with lower urinary tract symptoms (LUTS). METHODS: Forty-eight women with LUTS who underwent urodynamic study and BWT by ultrasonography as outpatients were studied. We assessed LUTS during a medical examination by interview. The thinnest part of the bladder wall was measured by a transabdominal ultrasonography. We excluded patients who had visited another hospital previously because we did not know what treatment they had received, including medications, behavioral therapy, or other treatments. We constructed receiver operating characteristic (ROC) curves for diagnosis of LUTD and also determined reliable BWT criteria by calculating the area under the curve. Statistical analyses were performed using the Kolmogorov-Smirnov method and Student's t-test. RESULTS: The mean age, body mass index, and duration of symptoms were 59.9±9.7 years, 26.06±3.4 kg/m², and 53.4±38.2 months, respectively. Urodynamic study parameters (Valsalva leak point pressure, maximal urethral closure pressure, functional length, and postvoid residual volume) were lower in patients with BWT < 3 mm; however, these differences were not significant. Patients with BWT ≥3 mm developed a hypoactive bladder (P=0.009) and intrinsic sphincter deficiency (ISD) (P=0.001) at a significantly higher rate. According to the ROC analysis, the best BWT cut-off value was 3 mm for overactive bladder diagnosis. CONCLUSIONS: Women with LUTD showed higher BWT values (≥3 mm), especially patients with hypoactive bladder and ISD. Sonographic evaluation of BWT is an easy, fast, and noninvasive method for possible diagnostic tool for LUTD.
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Female , Humans , Body Mass Index , Diagnosis , Lower Urinary Tract Symptoms , Methods , Outpatients , ROC Curve , Ultrasonography , Urinary Bladder , Urinary Bladder, Overactive , Urinary Tract , UrodynamicsABSTRACT
PURPOSE: Significant detrusor muscle hypertrophy is a well-recognized clinical finding observed benign prostate hyperplasia (BPH). This can be recognized as a bladder wall thickness (BWT) on transabdominal ultrasonography. The objective of this study was to assess the utility of a BWT measurement using ultrasound in patients with BPH. MATERIALS AND METHODS: A total of 197 men who underwent ultrasonic measurement of the BWT from August 1999 to August 2001 were enrolled in this study. Among them, 15 men comprised the normal control group, 145 men were in the symptomatic BPH group and 37 men were in the retention group. The BWT according to the clinical parameters (international prostate symptom score, peak flow rate, transverse diameter of prostate, age, duration of symptom, retention) was compared and analyzed. RESULTS: The mean BWT in the control group, BPH group and the retention group were 2.21+/-0.44mm, 3.39+/-0.87mm, 4.04+/-0.86mm, respectively. The BWT was well correlated with the international prostate symptom score (I-PSS), the peak flow rate (PFR), and age. The mean BWTs according to the I-PSS grouped into mild, moderate, and severe symptoms were 2.97 0.51mm, 3.12+/-0.68mm, 3.80+/-0.97mm, and the mean BWT according to PFR grouped into 15ml/sec were 3.65+/-0.93mm, 3.23+/-0.76mm, 2.91+/-0.58mm, respectively. The mean BWT according to age grouped into 50-59 years, 60-69 years 70-79 years, =80 years were 3.03+/-0.70, 3.47+/-0.68, 3.96+/-0.91, 4.60+/-1.25, respectively. Using the receiver operative characteristic curve (ROC curve), the cut-off BWT that can be used to distinguish the obstructive group was 3.60mm. CONCLUSIONS: The BWT can be measured noninvasively. From this study, the BWT can be a useful parameter for evaluating BPH.