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Objective:To observe any effect of functional magnetic stimulation (FMS) of the sacral 3 nerve root on relieving urine retention after a spinal cord injury.Methods:Forty-four patients with neurogenic bladder disorders after a spinal cord injury were divided at random into a 5Hz group ( n=14), a 20Hz group ( n=15), and a sham stimulation group ( n=15). In addition to conventional bladder control training, the 5Hz and 20Hz groups were given 20 minutes of FMS of the sacral 3 nerve root at the appropriate frequency five days a week for 4 weeks. The sham stimulation group was not given any stimulation. A detailed urination diary was kept during the treatment, and before and after the 4 weeks, everyone′s bladder pressure volume was assessed and an electromyogram was recorded. Results:After the treatment those in the 5Hz and 20Hz groups had improved significantly in terms of average bladder capacity, bladder pressure, residual urine volume, daily number of urethral catheterizations, daily micturition frequency, single urine output, H-reflex latency, and the amplitude and incubation period of the F wave. Those in the sham stimulation group showed no consistent improvement in any of these indicators. Moreover, the average residual urine volume, daily urination frequency and H-reflex latency and amplitude of the 20Hz group were significantly better than those of the 5Hz group.Conclusions:Magnetic stimulation of the S3 nerve roots can effectively improve the urination of persons with neurogenic bladder disorders after a spinal cord injury. The preferred frequency is 20Hz.
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Objective:To investigate the optimal bladder filling volume in the 3D brachytherapy of postoperative cervical cancer.Methods:Totally 111 early cervical cancer patients with positive incisal margins or insufficient safety boundaries were included. The normal saline 50, 60, 70, 80, 90, and 100 ml were filled into their bladders, and accordingly six groups were determined, and 66, 69, 66, 69, 72, 56 person-times in each group, respectively. The CT-based simulation positioning was performed. According to the ICRU 89 report, high-risk clinical target volume and organs at risk such as bladder and rectum were delineated. The Oncentra planning system was used to prepare the treatment program. The high-risk clinical target volume (HR-CTV), D90, and the D2 cm 3 and D1 cm 3 of organs at risk under different volumes were recorded. Results:Compared to the 60 ml group, the volume and dosage of HR-CTV in the groups of 50, 70, 80, 90, and 100 ml had no significant difference ( P>0.05). The D2 cm 3 and D1 cm 3 of the bladder and rectum of patients in these groups significantly decreased, and the difference was statistically significant ( tbladder = 3.21, 5.83, 2.89, 12.95, 7.96, Pbladder = 0.031, 0.010, 0.041, 0.000, 0.001; trectum = 2.94, 4.66, 2.53, 5.89, 4.13, Prectum = 0.037, 0.024, 0.049, 0.005, 0.028). The pairwise comparison among these groups except for the 60 ml group showed that the volume and dosage of HR-CTV and the D2 cm 3 and D1 cm 3 of bladder and rectum had no significant difference ( P > 0.05). Moreover, the D2 cm 3 and D1 cm 3 of sigmoid colon and small intestine of these groups had no significant difference ( P > 0.05). Conclusions:In the 3D brachytherapy of postoperative early cervical cancer, a bladder filling volume of 60 ml can ensure the volume and dose of HR-CTV and can protect the bladder and rectum compared with other filling volumes.
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OBJECTIVE@#To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity.@*METHODS@#Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200－400 mL. After 2－4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment.@*RESULTS@#The mean bladder volume of simulation (VCT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (VEVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (VBVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (VCBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between VEVA01 and VBVI01, VCT01 and VBVI01, VCT01, and VBVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(VEVA01) and simulation CT (VCT01) and differences of self-evaluation bladder volume before radiotherapy (VEVA01) and cone-beam CT (VCBCT), and there was no significant difference in paired samples by t-test.@*CONCLUSION@#During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.
Subject(s)
Humans , Male , Cone-Beam Computed Tomography , Prostatic Neoplasms , Radiotherapy Planning, Computer-Assisted , Urinary Bladder Neoplasms/radiotherapyABSTRACT
Background: Diabetic neuropathy is one of the commonest complications of diabetes mellitus and associated with considerable morbidity and mortality. The influence of diabetes on gall bladder function was not demonstrated in many studies. In this study, the association of fasting gall bladder volume and gall bladder ejection fraction with degree of cardiac autonomic neuropathy was assessed and correlated with duration of diabetes and severity of diabetes..Methods: The study was conducted in Government Sivagangai Medical College Hospital, Sivagangai, Madurai during a period of January 2018 to September 2018 as a Prospective observational study conducted among 100 patients in study group and 50 healthy subjects in control group. The aim of the study was to find out the incidence of autonomic neuropathy in study group by simple bed side tests, to determine the fasting gall bladder ejection fraction in diabetics, comparison of gall bladder volume in both study and control group, correlation of gall bladder ejection fraction with autonomic neuropathy.Results: The incidence of CAN is found to be high with longer duration of the disease and the degree is also correlated with duration of the disease. The correlation coefficient of this association is 0.792 which indicates high correlation. The correlation of severity of DM with incidence and degree of CAN was 0.81 which indicates high correlation and also the study showed an increase in the FGBV and a decrease in the GBEF with increase in the severity of cardiac autonomic neuropathy.Conclusions: In patients with type 2 diabetes mellitus, the gall bladder ejection fraction is significantly related to the duration of diabetes mellitus and degree of hyperglycemia in addition to cardiac autonomic neuropathy(CAN). Similarly, fasting gall bladder volume (FGBV) is significantly increased in type 2 diabetes mellitus patients with cardiac autonomic neuropathy.
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Objective To analyze the dosimetric effect of inconsistent bladder filling states between the CT simulation and treatment for prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT).Methods A total of 42 prostate cancer patients treated with IMRT were selected.After vacuum pad immobilization and simulation CT scan,the delineation of targets and organs-at-risk (OARs),treatment planning and dose calculation were performed on treatment planning system (TPS).The cone-beam-CT (CBCT) acquired before the first treatment was registered to planning CT,on which the target contours were duplicated and OARs were delineated.After dose recalculation on the CBCT using the same plan,the dosimetric differences on the CT and CBCT were compared,including mean dose of the planning target volume (PTV),homogeneity index (HI),conformity index (CI);the mean dose,V30,V40,V50,V60,and V65 of bladder and rectum respectively.Results Relative to the bladder volumes at simulation,the patients were divided into two groups with larger (15 cases) or smaller (27 cases) bladders at the first treatment.Comparing the parameters obtained from simulation CT with that from CBCT,the differences of the following parameters were of statistical significance:the bladder volume,PTV HI,PTV CI in both groups (t =6.838,-4.372,-3.553,-3.462,6.380,5.037,P＜ 0.05),the bladder V30,V40,V50,V60,V65(t=-5.004,-4.092,-3.124,-2.707,-2.489,P ＜0.05) and rectal V40,V50,V60,V65,mean dose in the group with smaller bladders (t=-2.946,-2.643,-2.426,-3.127,-2.530,P ＜ 0.05),and the bladder V30,V40,V50 and mean dose in group with larger bladders (t =5.107,4.204,3.777,4.155,P＜0.05).Conclusions For prostate cancer patients undergoing IMRT,the inconsistent bladder filling states between the planning and treatment will cause disimetric differences of targets and OARs.
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Objective To evaluate the feasibility of keeping the consistency of bladder filing by a Bladderscan ( BS ) device during radiotherapy for rectal cancer. Methods The bladder volume was measured using a BS device and recorded. To verify the reliability of the BS measurement, the urinary output was determined by a measuring glass after complete urinary discharge. The bladder volume of 42 patients determined by the planning computed tomography ( CT) scans was used as the standard urinary volume. The bladder volume was measured using the BS device before radiotherapy every day. The chief complaint urinary volume was determined as the bladder volume when a patient felt a strong urge to urinate. The controlled urinary volume was determined as the urinary output intervened by the BS device to reach the standard urinary volume. Comparison was made by t test and data was assessed by Pearson correlation analysis. Results There was no significant difference in obtained urinary volume between the BS device and the planning CT scan ( P=0?84) . The urinary volume measured by the measuring glass was correlated with that measured by the BS device ( P=0?00 ) . The ability to hold urine in all patients was gradually weakened during treatment. The controlled urinary volume had a significantly smaller decrease after 1, 2, 3, 4, and 5 weeks of treatment than the chief complaint urinary volume ( 5% vs. 21%;6% vs. 20%;6% vs. 20%, 4% vs. 21%;11% vs. 26%;all P=0?00) . Conclusions Patients have a gradually decreased urinary volume during treatment. The intervention by the BS device gives a bladder volume close to that in the planning system, which results in a consistent bladder filling.
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Objective To evaluate the effect of bladder volume change on the doses to normal tissues in cervical cancer patients undergoing external three-dimensional conformal radiotherapy (3DRT)plus 3D conformal brachytherapy (3DCBT).Methods The study included 56 patients with cervical cancer who were admitted to our hospital from 2012 to 2013 and received radical external 3DRT and 3DCBT.During 3DCBT,the doses to 0.1,1.0,and 2.0 cm3(D0.1 cm3,D1.0cm3,and D2.0cm3,respectively) for the rectum,small intestine,sigmoid colon,and bladder under different bladder filling status (empty,50,100,and 150 ml) were compared and analyzed by paired t-test.Results The rectum D0.1cm3 with bladder volumes of 50and 100 ml were significantly reduced compared with that with an empty bladder (P =0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the small intestine with bladder volumes of 50,100,and 150 ml were significantly reduced compared with those with an empty bladder (P =0.008,0.000,0.000 and 0.000,0.000,0.000 or 0.000,0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the bladder with bladder volumes of 100 and 150 ml were significantly increased compared with those with an empty bladder (P =0.000,0.000 and 0.000,0.000 or 0.000,0.000).Conclusions The doses to the bladder and small intestine are influenced by different bladder filling status,but the doses to the rectum and sigmoid colon show no significant variation.The increase in bladder volume is helpful in reducing the dose to the small intestine.Without any change in the bladder dose,the bladder volume of 50 ml is more beneficial to reduce the dose to the small intestine than those of 100 and 150 ml.
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PURPOSE: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. MATERIALS AND METHODS: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. RESULTS: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). CONCLUSION: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.
Subject(s)
Humans , Anastomotic Leak , Colon , Prone Position , Radiotherapy , Rectal Neoplasms , Urinary BladderABSTRACT
PURPOSE: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. MATERIALS AND METHODS: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. RESULTS: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). CONCLUSION: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.
Subject(s)
Humans , Anastomotic Leak , Colon , Prone Position , Radiotherapy , Rectal Neoplasms , Urinary BladderABSTRACT
Objective To investigate the biological safety of silicon membrane embedded permanent magnets implanted into canine, so as to evaluate the safety of a micturition alert device designed on the principle of compass. Methods Twelve adult male dogs (weighing 11-12 kg) were divided into experimental group (8 dogs) and control group (4 dogs ). The experimental group was implanted with a silicon membrane embedded NdFeB magnet, which was 10 mm in diameter and 3 mm in thickness and with a magnetic induction intensity of 0. 3 Tesla at the center of the pole face surface. The control group was implanted with a silicon membrane embedded NdFeB alloy with the same dimensions. The grafts were sutured onto the anterior surface of the bladder wall. The dogs were then allowed to live for one year. Both the survival and local pathology around the grafts were observed after implantation. And the pre-operation urine and post-operation urine were compared between the two groups. Results One dog in the experimental group died from operation complications 10 hours after operation, another dog had intestinal obstruction 3 weeks after operation because iron wires in the intestinal tract was caught up by the permanent magnet. The rest 6 dogs in the experimental group and 4 dogs in the control group had no abnormalities in spirit, appetite, urine or stool, and there were no infections. The animals were sacrificed one year after operation. Adhension was found between the epiploon and the bladder wall around permanent magnets in these 10 dogs; the fibrous capsule around the permanent magnets was thin, and the local bladder wall below permanent magnets was thickened, with normal bladder mucosa. Grade 2 inflammatory reaction and fibrous capsule of the local tissue were noted around the grafts. The findings of urine routine were normal before and after operation. Conclusion NdFeB permanent magnets embedded with silicon membrane are biologically safe for clinical application, which warrante further investigations.
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PURPOSE: Three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) were found to reduce the incidence of acute and late rectal toxicity compared with conventional radiation therapy (RT), although acute and late urinary toxicities were not reduced significantly. Acute urinary toxicity, even at a low-grade, not only has an impact on a patient's quality of life, but also can be used as a predictor for chronic urinary toxicity. With bladder filling, part of the bladder moves away from the radiation field, resulting in a small irradiated bladder volume; hence, urinary toxicity can be decreased. The purpose of this study is to evaluate the impact of bladder volume on acute urinary toxicity during RT in patients with prostate cancer. MATERIALS AND METHODS: Forty two patients diagnosed with prostate cancer were treated by 3DCRT and of these, 21 patients made up a control group treated without any instruction to control the bladder volume. The remaining 21 patients in the experimental group were treated with a full bladder after drinking 450 mL of water an hour before treatment. We measured the bladder volume by CT and ultrasound at simulation to validate the accuracy of ultrasound. During the treatment period, we measured bladder volume weekly by ultrasound, for the experimental group, to evaluate the variation of the bladder volume. RESULTS: A significant correlation between the bladder volume measured by CT and ultrasound was observed. The bladder volume in the experimental group varied with each patient despite drinking the same amount of water. Although weekly variations of the bladder volume were very high, larger initial CT volumes were associated with larger mean weekly bladder volumes. The mean bladder volume was 299+/-155 mL in the experimental group, as opposed to 187+/-155 mL in the control group. Patients in experimental group experienced less acute urinary toxicities than in control group, but the difference was not statistically significant. A trend of reduced toxicity was observed with the increase of CT bladder volume. In patients with bladder volumes greater than 150 mL at simulation, toxicity rates of all grades were significantly lower than in patients with bladder volume less than 150 mL. Also, patients with a mean bladder volume larger than 100 mL during treatment showed a slightly reduced Grade 1 urinary toxicity rate compared to patients with a mean bladder volume smaller than 100 mL. CONCLUSION: Despite the large variability in bladder volume during the treatment period, treating patients with a full bladder reduced acute urinary toxicities in patients with prostate cancer. We recommend that patients with prostate cancer undergo treatment with a full bladder.
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IncidenceABSTRACT
PURPOSE: Suprapubic bladder aspiration(SBA) is a widely accepted method of obtaining sterile urine for culture in neonates but has a relatively low success rate and a few serious complications during SBA procedure. To improve the chance of obtaining urine, we determined the ultrasonographic bladder parameters(diameters and volume) to confirm that the bladder is adequately distended for successful aspiration of urine. METHODS: In 94 newborn infants who required sterile collection of urine, ultrasonographic examination and SBA procedure were carried out. On the patient's suprapubic area, the maximal cephalocaudal and anteroposterior diameters were measured by sagittal scanning, and the maximal anteroposterior and transverse diameters by transverse scanning. Bladder volume was calculated using the formula for elliptic volume, and then urine was aspirated to maximum of 10 mL and the amount of urine aspirated was recorded. RESULTS: Sufficient urine for culture(>1 mL) was obtained by SBA in 86(91.5%) of 94 infants. In the sagittal view, when the cephalocaudal diameter of the bladder was greater than 20 mm and the anteroposterior diameter was greater than 15 mm, the success rate was 100%. The cephalocaudal diameter of the bladder in sagittal view showed a more significant positive correlation with aspirated urine amount(r=0.65, P<0.001). CONCLUSION: The ultrasonographic sagittal view improved the success rate of SBA in neonates. A SBA was more likely to be successful when the cephalocaudal diameter of the bladder was above 20 mm and the anteroposterior diameter was above 15 mm.
Subject(s)
Humans , Infant , Infant, Newborn , Ultrasonography , Urinary Bladder , Urinary Tract InfectionsABSTRACT
A noninvasive measurement of residual urine or bladder volume would reduce number of unnecessary catheterizations and be useful for an intermittent catheterization program in the management of neurogenic bladder. The purpose of this study is to evaluate a portable ultrasound instrument for the measurement of bladder volume and to assess the effect of several factors such as trabeculation or soft tissue thickness on the accuracy of the measurements. Nine patients with neurogenic bladder dysfunction underwent 480 bladder volume measurements using a portable ultrasonographic device(BVI-2500 BladderScan) before 60 intermittent catheterizations. Ultrasonographic measurements of urine volume were compared with catheterized urine volumes. The mean difference was 46.42+/-39.15 cc and the mean percentage error was 23.32+/-19.31%. Mean differences of each bladder capacity were not affected by bladder capacity, and mean percentage errors tend to decrease as the bladder capacity increase. Bladder trabeculation and soft tissue thickness had no effect on the accuracy of the measurements. The ultrasonographic measurements detected the presence of residual urine volumes of > or =100 cc with a sensitivity of 81% and a specificity of 93%. The repeatability(Mean/SD) was 23%. The accuracy had no correlation with the frequency of scanning. We conclude that BVI-2500 bladder scan portable ultrasonographic device is a useful tool for the management of neurogenic bladder dysfunction in spinal cord injured people. Trabeculation and soft tissue thickness has no effect on the accuracy of the measurements.