Discrimination of Bladder Disorders in Female Lower Urinary Tract Symptoms on Ultrasonographic Cystourethrography

Abstract

Objective. To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. Methods. Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. Results. Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. Conclusions. Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability. Key words: lower urinary tract symptoms; ultrasonography; urodynamics. Abbreviations HB, hypersensitive bladder; DI, detrusor instability; GSI, genuine stress incontinence; LUTS, lower urinary tract symptoms emale lower urinary tract symptoms (LUTS) are present in a heterogeneous group of disorders with varied pathogenesis. Because urinary symptoms are diagnostically unreliable, 1 it is appropriate to use urodynamic investigation and imaging studies as an integral part of evaluation of lower urinary tract disorders. Currently, videocystourethrography is a tool that simultaneously offers both urodynamic and anatomic assessment of the lower urinary tract. However, it is not widely available because of its sophistication and concerns about radiation exposure. Ultrasonography, which is noninvasive, easily reproducible, and without radiation, has replaced radiologic methods in anatomic evaluation of the lower urinary tract. [2][3][4][5][6]

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

“…In an update of the systematic review on the diagnostic accuracy of BWT in diagnosing DO (unpublished data: Suneetha Rachaneni, University of Birmingham, 2015) 21 studies 28,[49][50][51][52][53][54][55][56][57][58][59]72,97,[113][114][115][116][117][118][119] have been identified that have investigated the relationship between BWT measured by ultrasonography and DO, results from which for the sensitivity, specificity and AUC for bladder ultrasonography vary from 37% to 91%, 61% to 97% and 0.61-0.91, respectively (see Appendix 7). The studies draw mixed conclusions, ranging from…”

“…54 A subsequent update to the review identified seven further studies that have shown a significantly increased BWT in patients with DO than in patients without DO. 27,50,[55][56][57][58][59] However, the heterogeneity in the methods, including the standardisation of bladder ultrasonography and of UDS, and poor reporting of the proportions of DO cases identified as well as missed, precludes a formal diagnostic meta-analysis. Other methodological weaknesses of prior studies include unclear description of how bladder ultrasonography and UDS results were blinded to each other, recruitment mainly from a single centre and retrospective design.…”

“…Some transabdominal ultrasonography studies included men as well as women and usually were undertaken with a full bladder leading to much smaller measures of mean BWT. 116,119 Ten studies made comparisons with healthy controls, 28,50,[55][56][57][58][59][114][115][116] two others excluded patients with MUI 54,117 and one other enriched with women with equivocal UDS findings. 52 One was undertaken in patients with spinal injuries.…”

The significance of urethral hyperechogenicity in female lower urinary tract symptoms

“…From January 2002 to January 2003, 138 consecutive women with lower urinary tract symptoms (frequency, nocturia, urgency, urge or stress incontinence, or voiding dysfunction) for at least 3 months who had undergone functional evaluation of the lower urinary tract by multichannel urodynamic testing together with morphological assessment of the lower urinary tract by ultrasound cystourethrography7, 9 were enrolled in this study. Exclusion criteria included: (1) hematuria, recurrent dysuria, abnormal urinalysis or positive urine culture; (2) a history of pelvic surgery, neuropathy (central or peripheral), diabetes mellitus or radiation therapy or (3) estrogen replacement therapy for postmenopausal symptoms.…”

“…We performed introital and transvaginal ultrasonography with a Toshiba SSA‐260A (Toshiba, Tokyo, Japan) or Voluson 730 (Medison‐Kretztechnik, Zipf, Austria) scanner and an endovaginal probe with a frequency range of 5.0–9.0 MHz. The morphology of the lower urinary tract was evaluated at rest and during a maximum Valsalva maneuver as described in a previous study9. Color Doppler imaging was performed with pulse repetition frequency of 4.0 kHz and wall filters of 50 Hz.…”