Prediction of myometrial invasion of bladder cancer based on texture analysis of the bladder wall at tumor base / 中华超声影像学杂志

Objective:To identify the value of ultrasound radiomic features extracted from the bladder wall at tumor base in predicting myometrial invasion of bladder cancer.Methods:A total of 175 cases with bladder cancer confirmed by pathology from January 2017 to February 2022 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. They were divided into training set and testing set in a ratio of 7∶3. The MaZda texture analysis software was used to draw the region of interest (ROI) of the bladder wall and the tumor region for extracting texture features. The minimum absolute reduction and variable selection operator (LASSO) regression and 10-fold cross-validation were used to screen the features of training set for establishing the models. And the ROC curve was used to evaluate the efficiency of the models.Results:A total of 279 texture features were extracted from the ROI of the bladder wall and the tumor region, and 5 texture features were screened out for constructing omics scoring models by LASSO regression and 10-fold cross-test. The area under ROC curve (AUC)s used in training set and testing set of the bladder wall were 0.921 and 0.856, while the AUCs applied in training set and testing set of the tumor region were 0.849 and 0.704. Both in the training set and test set, the AUCs of the model of the bladder wall were higher than those of the model of the tumor region (all P<0.05). Conclusions:The omics scoring model based on the texture features of the bladder wall at tumor base can effectively identify muscle-invasive bladder cancer(MIBC) and non-muscle-invasive bladder cancer(NMIBC), and has better performance than the model based on the texture feature of the tumor region.

A Clinical Study on Correlation of Non-Invasive Diagnostic Tests in Evaluation and Management of Patients with Symptomatic Benign Prostatic Hyperplasia

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

The value of bladder wall thickness in predicting upper urinary tract damage in patients with neurogenic lower urinary tract dysfunction / 中华泌尿外科杂志

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.

Sonographic evaluation of bladder wall thickness in women with lower urinary tract dysfunction

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.

A feasibility study of the automatic cystocele severity grading software for quantitative evaluation of prolapse of bladder posterior wall by transperineal ultrasound / 中华超声影像学杂志

Objective To investigate the feasibility of the automatic cystocele severity grading software for quantitative evaluation of prolapse of bladder posterior wall by transperineal ultrasound . Methods One hundred and seventy transperineal ultrasound video clips were recorded when the female patients performing the Valsalva maneuver and those clips were divided into training group ( 85 cases) and test group ( 85 cases) randomly ,then the ralated structures of the images from the training group offline were marked . Through machine learning algorithm ,the computer had learned and was able to analyzed the marking information ,then the automatic cystocele severity grading software was obtained . And later the software was ran to mark the structures and get the cystocele severity grading in the images from the test group . Meanwhile , the same structures of the same images manually were marked and after an interval of more than two weeks the process were repeated by 3 doctors . Finally the grading results obtained from the software and the measurers of the 3 doctors were compared . Results The intelligent identification and automatic measurement software obtained from the machine learning algorithm was able to identify the related structures . The grading results of each measurer were of good consistency ( κ :0 .72 －0 .78 ;ICC :0 .980－0 .990) . The grading results between different measurers were of good consistency ( κ :0 .65－0 .75 ;ICC :0 .985－0 .992) . The grading results between automatic software and three different measurers were of good consistency ( κ :0 .63－0 .67 ;ICC :0 .967－0 .969 ; r ＝0 .936 ,0 .943 ,0 .936 ,all P ＜0 .01) . Conclusions The automatic cystocele severity grading software is able to identify the related structures in the images and reliable to apply the software in pelvic floor ultrasound .

The efficacy of construction of neourethra using a bladder anterior wall for treatment of female total urethral stricture or atresia / 中华泌尿外科杂志

Objective To explore the efficacy of constructing the neourethra using a bladder anterior wall for the treatment of female total urethral stricture or atresia.Methods We retrospectively reviewed 11 female patients with total urethral stricture or oblitalition,who were underwent a procedure of reconstructive neourethra using a bladder anterior wall,from January 2009 to November 2015.Of the 11 patients,urethral stricture was associated with vesicovaginal fistula and a severe hydrocolpos in the proximal vagina because of vaginal anterior strictures or atresia in four girls.The mean age was 16 years (ranging 5-48 years) in all patients.The etiology was posttraumatic urethral injuries after pelvic fracture in 9 patients,radical urethral resection because of urethral cancer in 1 patient and congenital bladder exstrophy with an absent urethra in 1 patient.All patients underwent a procedure of neourethral construction under general anesthesia.The bladder anterior wall,which was about 2.0 to 2.5 cm in width and 4.0 ～4.5cm in length,was separated from bladder neck to middle partion of the anterior bladder wall.The bladder flap was tubularized around a 12-14 French catheter using continuous 4-0 polyglycolic acid sutures for the mucosa and interrupted sutures of 3-0 polyglycolic acid for the muscle.The tubularized flap was then flipped caudally to the site of the original external urethral meatus to form a new urethra.4 patients with severe stenosis or oblitalition of the distal vagina underwent a procedure of vaginoplasty at same time,including island vulvar flaps enlarging vaginoplasty in two girls and reconstructive vaginal orifice using the proximal enlargedvagina wall in other two girls.Results There were no serious complications postoperatively.The catheter was removed 3 ～4 weeks after the operation.7 patients were completely continent with excellent voiding,3 patients had stress incontinence.One patient experienced dysuria.And the urethroscopy in this case showed that the mucosal prolapse was present at the 12 to 3 o'clock position on the neck of the bladder,which caused urinary obstruction.Endoscopic resection of the prolapsed mucosa was performed.The patient could easily void without incontinence after the operation.The patients were followed up a median of 38 months,(ranging 6-72 months).2 patients experienced dysuria 3 and 4 months after operation,separatively.Examination showed that the mucosal prolapse was present at the position on the neck of the bladder in one patient and urethral meatal stenosis in another patient.The two patients were separatively underwent a procedure of endoscopic resection of the prolapsed mucosa and meatal urethroplasty,using vulvar flap.All of them could easily void without incontinence after the operation.Of the 3 patients with stress urinary incontinence,one underwent a procedure of TVT-O one year later,and after which continence was achieved with good voiding;the other two cases were awaiting for reoperation.Four cases of postoperative vaginal fluid disappeared with unobstructed micturition.Conclusions Female neo-urethral reconstruction using the bladder anterior wall flap was a reliable technique for the management of complete urethral stricture or obliteration.

Ultrasonic diagnosis and clinical analysis of eosinophilic cystitis in children / 中华实用儿科临床杂志

Objective To explore the ultrasound imaging and the clinical analysis of eosinophilic cystitis in children and to improve the understanding of this very rare clinical disease.Methods The ultrasound imaging of 9 patients who were diagnosed as eosinophilic cystitis in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Jul.2007 to May 2013 were analyzed retrospectively,and the relevant literatures were reviewed.Results The ultrasound imaging of the 9 patients were described as follows:4 cases showed a diffuse thickening bladder wall,2 cases showed a localized mass-like thickening bladder wall,and 3 cases showed a markedly thickening anterior bladder wall and bilateral bladder wall.Laboratory studies showed that all the patients were presented with eosinophilia.Six patients underwent cystoscopy that showed an erythematous,and velvety appearance of the bladder mucosa.Histopathology disclosed a bladder mucosal tissue with dense interstitial eosinophilic infiltration consistent with eosinophilic cystitis.Three patients had clinical resolution under the treatment of anti-infections and urine alkalinization.Other 6 patients received prednisone at 0.5-1.0 mg/kg and an antihistamine treatment.Prednisone was eventually tapered off after 2-week reemission.Regular follow-up by urinary bladder ultrasound and urine routine did not show any disease recurrence in 9 children.Conclusions The combination of bladder wall thickening and peripheral eosinophilia may suggest the likely diagnosis of eosinophilic cystitis.Cystoscopy with bladder biopsy is the most important step in the diagnosis of eosinophilic cystitis.Anti-histamines and corticosteroids can be used as the primary management and have good results.

Human Adipose Tissue Derived Stem Cells as a Source of Smooth Muscle Cells in the Regeneration of Muscular Layer of Urinary Bladder Wall

Background: Adipose tissue provides an abundant source of multipotent cells, which represent a source of cell-based regeneration strategies for urinary bladder smooth muscle repair. Our objective was to confirm that adipose-derived stem cells (ADSCs) can be differentiated into smooth muscle cells. Methods: In this study, adipose tissue samples were digested with 0.075% collagenase, and the resulting ADSCs were cultured and expanded in vitro. ADSCs at passage two were differentiated by incubation in smooth muscle inductive media (SMIM) consisting of MCDB I31 medium, 1% FBS, and 100 U/mL heparin for three and six weeks. ADSCs in non-inductive media were used as controls. Characterisation was performed by cell morphology and gene and protein expression. Result: The differentiated cells became elongated and spindle shaped, and towards the end of six weeks, sporadic cell aggregation appeared that is typical of smooth muscle cell culture. Smooth muscle markers (i.e. alpha smooth muscle actin (ASMA), calponin, and myosin heavy chain (MHC)) were used to study gene expression. Expression of these genes was detected by PCR after three and six weeks of differentiation. At the protein expression level, ASMA, MHC, and smoothelin were expressed after six weeks of differentiation. However, only ASMA and smoothelin were expressed after three weeks of differentiation. Conclusion: Adipose tissue provides a possible source of smooth muscle precursor cells that possess the potential capability of smooth muscle differentiation. This represents a promising alternative for urinary bladder smooth muscle repair.

Grosor de la pared vesicular en pacientes con hipertensión portal: Utilidad clínica

Introducción: El engrosamiento de la pared vesicular se halla poco frecuente en el ultrasonido abdominal de pacientes con cirrosis hepática e hipertensión portal. En este trabajo se determinó cual es su importancia en relación con la presencia de varices esofágicas y otras variables. Pacientes y Métodos: Estudio prospectivo y comparativo con un grupo de pacientes con Cirrosis hepática e hipertensión portal y otro control sin Enfermedad hepática. Se realizaron pruebas hepáticas, ultrasonido abdominal, doppler de la vena porta y endoscopia digestiva superior. Resultados: Se evaluaron 25 pacientes: 14 casos y 11 controles, edad promedio 46,28 + 17,47 vs 38,27 +10,63. Las diferencias entre ellos fueron: Diámetro de vena porta 10,78 + 2,54 vs 8,63 + 1,80 mm, p=0,02; Albúmina sérica 3,16 + 0,83 vs 4,13 + 0,48 gms., p=0,003 y grosor de pared vesicular 3,51 + 1,45 vs 1,77 + 0,45mm, p=0,0009). La sensibilidad del engrosamiento de la pared vesicular para el diagnóstico de varices esofágicas resultó 80 %, especificidad 93,3 %, Valor predictivo positivo 89 % y valor predictivo negativo 88 %. Se encontró asociación entre grosor de la pared vesicular, albúmina (r=0,5347, p=0,005) y el diámetro de la porta (r=0,4105, p= 0,041). No hubo diferencias en cuanto a Velocidad sistólica máxima p=0,13; Velocidad diastólica final p=0,22; ¸ndice de resistencia p=0,15, Flujo sanguíneo portal: p=0,94. No se logró demostrar relación entre el Grosor de pared vesicular y el Child Pugh (r=0,25, p= 0,386). Conclusiones: Existe relación entre el grosor de la pared vesicular y la presencia de varices esofágicas en los pacientes con cirrosis hepática.

Objetive: The thickening of the gall bladder wall is little common in the abdominal ultrasound of patients with liver cirrhosis and portal hypertension. In this work it was determined its importance in relation with the presence of esophageal varices and other variables. Patients and Methods: A prospective and comparative study was made (cases and controls). A group of patients with liver Cirrhosis and portal hypertension and another control without liver Disease. Were made Liver tests, abdominal ultrasound, Doppler of the porta vein and upper endoscopy. Results: Evaluated 25 patients; 14 cases patients, and 11 patients controls, mean age 46.28 ± 17.47 vs 38.27 ± 10, 63. Differences between them were: Vein diameter porta 10.78 + 2.54 vs 8.63 + 1.80mm, p=0,02; Seric albumin 3.16 + 0.83 vs. 4.13 + 0.48 gm, p=0,003 and gall bladder wall thickness 3.51 + 1.45 versus 1.77 + 0,45mm, p=0,0009. The sensitivity of the thickening gall bladder wall for the diagnosis of esophageal varices was of 80%, specificity 93.3%, predictive value positive 89% and predictive value negative 88%. Association was found between thickness of the gall bladder wall and albumin (r=0,5347, p=0,005) and the diameter of the porta (r=0,4105, p= 0.041). There was not differences respect to speed systolic Maximum p=0,13; diastolic speed final p=0,22; resistance index p=0,15; blood Flow portal: p=0,94. No profit to demonstrate between the Thickness of gall bladder wall and the Child Pugh (r=0, 25, p= 0.386).Conclusions: Relationship betwen the gall bladder wall thickening and the presence of esophageal varices in patients with cirrhosis of the liver and portal hypertension.

The Usefulness of Bladder Wall Thickness Measurement Using Ultrasound in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

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.