Transabdominal ultrasonography of detrusor wall thickness in women with overactive bladder

Study Type – Diagnostic (case series)
Level of Evidence 4

OBJECTIVE

To determine the clinical usefulness of measuring detrusor wall thickness (DWT) as a noninvasive test in women with overactive bladder (OAB).

PATIENTS, SUBJECTS AND METHODS

We prospectively enrolled 122 women with dry OAB, wet OAB, and women with no OAB symptoms (control group). A 3‐day voiding diary was used to differentiate between wet and dry OAB. Transabdominal ultrasonography (TAUS) measurements of DWT were taken at bladder volumes of 250–300 mL and the maximal bladder capacity by both catheter‐ and natural‐filling. Video‐urodynamic studies (VUDS) were used to classify bladder dysfunction in 88 of the women.

RESULTS

The mean (range) age of the women was 58 (20–94) years. There were 39 ‘normal’ controls, 44 women had dry OAB, and 39 had wet OAB. Of the 88 women who had VUDS, 28 had a ‘normal’ test, 30 had increased bladder sensation (IBS), and 30 had detrusor overactivity (DO). The mean DWT at 250–300 mL among three symptomatic subgroups or urodynamic subgroups showed no significant difference by either catheter‐ or natural‐filling methods. The women with wet OAB had significantly greater DWTs than the controls at maximal bladder volume. The maximal bladder capacity was significantly greater in ‘normal’ women than in those with OAB. If we corrected maximal bladder volume to 250 mL, DWT at corrected 250 mL showed no significant difference among three symptomatic subgroups.

CONCLUSIONS

DWT measured by TAUS in women with OAB and without OAB was not different and did not differ with urodynamic status. Thus, TAUS measurement of DWT is not recommended as a useful diagnostic test for DO in women with OAB.     

Advantage of transvaginal over transabdominal sonography.

Results with transvaginal sonography (TVS), a new ultrasound diagnostic method, are reported. A total of 40 patients were comparatively examined by transvaginal and transabdominal sonography. In contrast to transabdominal sonography, the transvaginal examination provided additional information in 35% of the patients. The indications and advantages of transvaginal sonography are summarized as compared with the traditional method. The introduction of the method is recommended in all US laboratories where examinations of the pelvis are performed.     

经超声逼尿肌厚度测定在可疑膀胱出口梗阻患者中的应用

目的 分析可疑膀胱出口梗阻患者术前逼尿肌厚度,探讨逼尿肌厚度测定对可疑膀胱出口梗阻患者术后疗效的预测作用.方法 对可疑膀胱出口梗阻并行手术治疗的86例患者在行压力流率测定过程中,当膀胱容量为250 ml或灌注量为膀胱最大容量的50%时,应用7.5 MHz高频线纵超声探头行膀胱前壁逼尿肌厚度测定.术后3个月复查,将患者分为疗效显著组与疗效非显著组,比较2组患者年龄、前列腺体积及逼尿肌厚度.结果 疗效显著组(37例)与疗效非显著组(49例)患者年龄及前列腺体积差异无统计学意义(P＞0.05).逼尿肌厚度差异有统计学意义[(2.5±0.3)和(2.2±0.3)mm,P＜0.01].应用受试者工作特性曲线,当逼尿肌厚度≥2.8 mm时,逼尿肌厚度测定作为预测工作特异性和阳性预测值均为100%,而敏感性为19%,阴性预测值为62%.其曲线下面积为0.84±0.04.结论 逼尿肌测定预测可疑膀胱出口梗阻患者术后疗效可靠,但仍需要多中心、大样本的试验进一步确定临界值.

Abstract：

Objective To estimate the application of ultrasound measurement of detrusor wall thickness (DWT) in the assessment of curative effect after operation. Methods Detrusor thickness was measured by linear ultrasound (7. 5 MHz) either at a filling volume of 50% of cystometric capacity or at 250 ml filling in 86 patients, who were diagnosed equivocal BOO, during a pressure-flow study. All patients accepted transurethral resection of the prostate. At 3 months post-surgery, the patients were divided into two groups according to curative effect after operation. The volume of the prostate, age and DWT were compared between the two groups. Results There was no difference in either age or volume of the prostate between the two groups. DWT was significantly higher (P＜0.01) in the more curative effect group (37 cases, DWT 2. 5±0.3 mm) compared to the less curative effect group (49 cases, 2.2±0. 3 mm). As a predictor of curative effect, DWT of 2. 8 mm or greater had a positive predictive value of 100%, a negative predictive value of 62%, specificity of 100% and sensitivity of 19%. Receiver operating characteristic analysis (ROC) revealed that DWT had a high predictive value for curative effect post-surgery with an AUC of 0. 84±0. 04. Conclusions In patients with equivocal BOO, ultrasonographically assessed detrusor thickness may have a predictive value for curative effect post-surgery. However, this cutoff value needs to be validated in a larger study population.     

Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men

Purpose

Detrusor underactivity (DU) has lately gained increasing interest because this bladder condition is an important cause of post-void residual urine and lower urinary tract symptoms (LUTS) in adult men. Until now, DU can only be diagnosed by pressure–flow measurement. Therefore, the aim of this study was to search for noninvasive tests which can safely predict DU in adult men.

Methods

Unselected, treatment-naïve male patients aged ≥40 years with uncomplicated, non-neurogenic LUTS were prospectively evaluated. All men received—after standard assessment of male LUTS–ultrasound detrusor wall thickness (DWT) measurements at a bladder filling ≥250 ml and computer urodynamic investigation. DU was defined as incomplete bladder emptying (>30 ml) in the absence of bladder outlet obstruction or dysfunctional voiding. Classification and regression tree (CART) analysis was used to determine parameters and threshold values for DU.

Results

The study population consisted of 143 consecutive men with medians of 62 years, IPSS 16, and prostate volume 35 ml. In total, 33 patients (23.1 %) had DU. CART analysis showed that all men with DWT ≤ 1.23 mm plus bladder capacity >445 ml had DU. This multivariate model has a sensitivity of 42 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 85 %.

Conclusions

This study showed that all men with ultrasound DWT ≤ 1.23 mm + bladder capacity >445 ml have DU. Combination of these two tests could help physicians to diagnose DU noninvasively in clinical practice. A prospective independent study should confirm these results.

     

Ultrasound measurement of bladder wall thickness in different forms of detrusor overactivity

Introduction and hypothesis  

Aims of this study were to compare the ultrasound measurement of bladder wall thickness (BWT) in women with different urodynamic diagnosis and to correlate BWT to the different urodynamic findings of detrusor overactivity (DO).     

Clinical and urodynamic differences among women with overactive bladder according to the presence of detrusor overactivity

Introduction and hypothesis

We tried to determine whether clinical and urodynamic differences exist between women with and without detrusor overactivity (DO) using a large database of overactive bladder (OAB) patients.

Methods

We reviewed the medical records of 513 women who underwent urodynamic studies for OAB symptoms without neurogenic or anatomical conditions that affect micturition function. Clinical symptoms were evaluated using a 3-day frequency-volume chart (FVC) including the Urinary Sensation Scale and American Urological Association Symptom Index (AUA-SI). All clinical and urodynamic findings were compared between women with and without DO.

Results

The patients’ mean age was 58.9 years. DO was identified urodynamically in 167 (32.6 %) women. Those with DO were older (62.9 vs 57.0 years, p?<?0.001); however, no differences in AUA-SI, episodes of daytime voiding, and episodes of nocturia were observed between the groups. Functional bladder capacity was smaller in women with DO; however, this difference did not reach statistical significance. Women with DO had significantly more urgency incontinence symptoms than those without DO (55.1 vs 29.5 %, p?<?0.001). In urodynamic parameters, the volumes at first desire to void and strong desire to void and maximum cystometric capacity were significantly smaller, and detrusor pressure at the opening was significantly higher in women with DO compared to subjects without DO (26.2 vs 21.2 cmH₂O, p?=?0.004).

Conclusions

Our findings suggest a more severe disturbance of bladder function when DO exists, although no differences were observed in symptom scores and 3-day FVC parameters among women with OAB symptoms according to the presence of DO.     

经超声逼尿肌厚度测定在无创诊断女性膀胱出口梗阻中的应用

目的 探讨经超声逼尿肌厚度测定在女性膀胱出口梗阻诊断中的应用价值.方法 93例伴有LUTS的女性患者,行压力流率测定过程中,当膀胱容量为250 ml或最大膀胱容量的50％时,应用7.5 MHz高频线纵超声探头测定膀胱前壁逼尿肌厚度.以Qmax≤12 ml/s以及最大尿流率时逼尿肌压力≥25 cm H2O(1 cm H2O =0.098 kPa)作为诊断女性膀胱出口梗阻的标准,将患者分为梗阻及非梗阻两组,比较两组年龄、尿动力学参数及逼尿肌厚度的差异.应用相对工作特征曲线评价逼尿肌厚度测定作为诊断工具的价值. 结果 梗阻组42例,非梗阻组51例.两组年龄分别为(61.2±8.3)、(59.9±7.7)岁(P=0.44),最大膀胱灌注容量分别为(292.2±82.3)、(308.1±87.5)ml(P =0.37),组间比较差异均无统计学意义;两组最大逼尿肌压力[(43.1±11.2)、(16.2±7.1)cm H2O,P=0.00]、最大尿流率时逼尿肌压力[(34.3±8.2)、(13.1±7.8)cm H2O,P=0.00]、Qmax[(7.4±3.2)、(17.4±4.1)ml/s,P=0.00]、排尿量[(157.1±63.7)、(251.2±77.4)ml,P=0.00]、残余尿量[(117.5±71.3)、(37.7±18.1)ml,P=0.00]及逼尿肌厚度[(1.8±0.3)、(1.4±0.2)mm,P =0.00]比较差异均有统计学意义.当临界值≥1.9 mm时,特异性和阳性预测值均为100％,敏感性为38％,阴性预测值为62％.其曲线下面积为0.88±0.06. 结论 经超声逼尿肌厚度测定诊断女性膀胱出口梗阻具有无创、方便、可靠的特点.当临界值≥1.9 mm时,具有较高的特异度和阳性预测值,在一定程度上可取代压力流率测定.     

Voiding urgency and detrusor contractility in women with overactive bladders.

AIMS: To check whether the contractility of overactive bladders would be affected by voiding urgency. METHODS: We urodynamically studied 100 women: 20 normal controls (group 1), 60 patients with idiopathic detrusor overactivity (DO), and 20 with neurogenic DO from intracerebral lesions. The idiopathic DO groups 2A (n = 20), 2B (n = 20), and 3 (n = 20) had moderate, severe, and no voiding urgency, respectively. The neurogenic DO group 4 had severe urgency. The delay time of urgent void at cystometry (2 minutes or more or, respectively, less than 2 minutes) defined moderate or severe urgency. Detrusor contractility was defined by the maximum bladder external voiding power (WF(max)). RESULTS: WF(max) was higher in the idiopathic DO patients than in the controls, had the highest values in group 2B, and did not differ significantly between groups 1-4 and 2A-3. CONCLUSIONS: We inferred from our data that idiopathic DO suggests a facilitation of voiding contractions and that such facilitation might be centrally amplified by severe urgency. This amplifying effect would probably be impaired in cases of neurogenic DO from intracerebral lesions.     

Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men

Detrusor wall thickness decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, detrusor wall measurements were performed in patients when the bladder was filled to maximum capacity only. Mean detrusor wall thickness for unobstructed (n = 14), equivocal (n=23) and obstructed patients (n=33) were 1.33, 1.62 and 2.4 mm, respectively (P <0.001). With increasing CHESS letters and CHESS numbers, the thickness of the detrusor wall increased as well (P< 0.001). The positive predictive value of detrusor wall measurement (95.5% for a cut-off value greater than or equal to 2 mm) was superior to all other predictors investigated. The thickness of the detrusor wall increases depending on the extent of BOO. Both constrictive and compressive BOO lead to an increase in detrusor wall thickness. BOO is found in 95.5% of men with a detrusor wall thickness greater than or equal to 2 mm. Measuring the thickness of the detrusor wall can be used as a screening test to detect BOO.     

Severe depression and anxiety in women with overactive bladder

Aim

Depression and anxiety are prevalent psychiatric conditions and are associated with overactive bladder. The objective of this study was to determine prevalence and severity of anxiety and depression associated with overactive bladder (OAB) in women.

Methods

274 women with clinical diagnosis of OAB were recruited from 2012 to 2015. They were submitted to the International Consultation on Incontinence Questionnaire‐Overactive Bladder (ICIQ‐OAB), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results

Severe or moderate depression was present in 59.8% of women and severe or moderate anxiety was identified in 62.4%. Higher scores of depression and anxiety were associated with higher scores of ICIQ‐OAB (P = 0.0031 and 0.0049). Women with severe depression had higher nocturia score than those with mild depression (P = 0.0046). Also, women with severe depression had higher urgency incontinence score than those with minimal depression (P = 0.0261). Patients with severe anxiety had higher nocturia score than those with minimal anxiety (P = 0.0118) and women with moderate anxiety had higher urgency incontinence score than with minimal anxiety (P = 0.0300).

Conclusions

Moderate or severe depression and anxiety are prevalent in women with OAB. There is a correlation between intensity of OAB symptoms with depression and anxiety. Anxiety and depression levels are mainly related with urgency incontinence and nocturia.