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      The use of ultrasound-estimated bladder weight in diagnosing bladder outlet obstruction and detrusor overactivity in men with lower urinary tract symptoms

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          Abstract

          Objectives:

          Measurement of bladder weight using ultrasound estimates of bladder wall thickness and bladder volume is an emerging clinical measurement technique that may have a role in the diagnosis of lower urinary tract dysfunction. We have reviewed available literature on this technique to assess current clinical status.

          Methods:

          A systematic literature search was carried out within PubMed and MedLine to identify relevant publications. These were then screened for relevance. Preliminary results from our clinical experiments using the technique are also included.

          Results:

          We identified 17 published papers concerning the technique which covered clinical studies relating ultrasound-estimated bladder wall thickness to urodynamic diagnosis in men, women, and children together with change in response to treatment of bladder outlet obstruction. The original manual technique has been challenged by a commercially available automated technique.

          Conclusion:

          Ultrasound-estimated bladder weight is a promising non-invasive technique for the categorization of storage and voiding disorders in both men and women. Further studies are needed to validate the technique and assess accuracy of diagnosis.

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          Most cited references30

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          Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume.

          The aim of this prospective study was to compare the diagnostic accuracy of detrusor wall thickness (DWT), free uroflowmetry, postvoid residual urine, and prostate volume (index tests) with pressure-flow studies (reference standard) to detect bladder outlet obstruction (BOO) in men. During a 2-yr period, men older than 40 yr with lower urinary tract symptoms and/or prostatic enlargement had the following tests: ultrasound measurements of DWT, free uroflowmetry (Q(max), Q(ave)), postvoid residual urine, and prostate volume. Pressure-flow studies were used to divide obstructed from nonobstructed bladders. One hundred sixty men between 40-89 yr of age (median: 62 yr) were included in the study; 75 patients (46.9%) had BOO according to pressure-flow studies. The results of all investigated index tests differed significantly between obstructed and nonobstructed men. DWT was the most accurate test to determine BOO: the positive predictive value was 94%, specificity 95%, and the area under the curve of ROC analysis 0.93. There was an agreement of 89% between the results of DWT measurement and pressure-flow studies. Measurements of DWT can detect BOO better than free uroflowmetry, postvoid residual urine, or prostate volume. In clinical routine, DWT measurements can be used to judge BOO noninvasively. European Association of Urology.
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            The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness.

            The objective of the study was to investigate specificity and sensitivity of bladder wall thickness in the diagnosis of bladder outlet obstruction. The study included 174 patients referred to our prostate centers for lower urinary tract symptoms. Free uroflowmetry and pressure-flow studies were performed in duplicate as part of the diagnostic evaluation. After the 2 voiding studies were done the bladder was filled to 150 ml. and wall thickness was measured via suprapubic ultrasound. Bladder outlet obstruction was diagnosed and graded according to the Abrams-Griffiths and Schäfer nomogram as well as to the group specific urethral resistance algorithm. A significant correlation (r > 0.6, p < or = 0.007) was found between bladder wall thickness and all parameters of the pressure-flow study. A bladder wall thickness of 5 mm. appeared to be the best cutoff point to diagnose bladder outlet obstruction, since 63.3% of patients with bladder wall thickness less than 5 mm. were unobstructed while 87.5% of those with a bladder wall thickness 5 mm. or greater were obstructed. Bladder wall thickness out performed uroflowmetry in terms of specificity and sensitivity in the diagnosis of outlet obstruction as demonstrated by an area under curve value of 0.860 versus 0.688 in the receiver operator characteristics analysis. Measurement of bladder wall thickness appears to be a useful predictor of outlet obstruction with a diagnostic value exceeding free uroflowmetry although it does not represent a substitution to invasive urodynamics. These data support the hypothesis that the relationships between morphology and function are of clinical importance.
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              The ICS-'BPH' Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction.

              To explore the relationship between uroflow variables and lower urinary tract symptoms (LUTS): to define performance statistics (sensitivity, specificity, positive and negative predictive values) for maximum urinary flow rate (Qmax) with respect to bladder outlet obstruction (BOO) at various threshold values; and to investigate the diagnostic value of low-volume voids. The study comprised 1271 men aged between 45 and 88 years recruited from 12 centres in Europe, Australia, Canada, Taiwan and Japan over a 2-year period. Symptom questionnaires, voiding diaries, uroflowmetry and pressure-flow data were recorded. The relationship between uroflow variables and symptoms, Qmax and BOO, and the diagnostic performance of low volume voids were analysed. The relationship between symptoms and uroflow variables was poor. The mean difference between home-recorded and clinic-recorded voided volumes was -48 mL. Qmax was significantly lower in those with BOO (9.7 mL/s for void 1) than in those with no obstruction (12.6mL/s; P 150 mL the likelihood of BOO was 56%. The addition of a specific threshold of 10 mL/s to these higher volume voiders improved the PPV for BOO to 69%. While uroflowmetry cannot replace pressure-flow studies in the diagnosis of BOO. it can provide a valuable improvement over symptoms alone in the diagnosis of the cause of lower urinary tract dysfunction in men presenting with LUTS. This study provides performance statistics for Qmax with respect to BOO: such statistics may be used to define more accurately the presence or absence of BOO in men presenting with LUTS, so avoiding the need for formal pressure-flow studies in everyday clinical practice, while improving the likelihood of a successful outcome from prostatectomy. This study also shows that low-volume uroflowmetry can provide useful diagnostic information and that, as such, the data from such voids should not be discarded.
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                Author and article information

                Journal
                Indian J Urol
                IJU
                Indian Journal of Urology : IJU : Journal of the Urological Society of India
                Medknow Publications (India )
                0970-1591
                1998-3824
                Jan-Mar 2009
                : 25
                : 1
                : 105-109
                Affiliations
                Bristol Urological Institute, Bristol, UK
                Author notes
                For correspondence: Dr. Fadi Housami, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK. E-mail: fhousami@ 123456bui.ac.uk
                Article
                IJU-25-105
                10.4103/0970-1591.45547
                2684305
                19468439
                e7e8d790-84d9-4be5-b7be-7970d2121a8c
                © Indian Journal of Urology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Symposium

                Urology
                bladder weight,bladder outlet obstruction,detrusor overactivity,bladder wall thickness
                Urology
                bladder weight, bladder outlet obstruction, detrusor overactivity, bladder wall thickness

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