The aging bladder: morphology and urodynamics

Elbadawi, Ahmad; Diokno, Ananias C.; Millard, R. J.

doi:10.1007/pl00014134

Cited by 78 publications

(37 citation statements)

References 118 publications

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“…The small increase in BWT with age could be related to detrusor hypertrophy or secondary to increased interstitial collagen deposition. 45 As the age-related increase in the thickness is small, and smaller than the likely measurement error of ultrasonography, correction with respect to age may not be required. The optimum bladder volume to measure BWT is still a matter of debate.…”

Section: Bladder Ultrasonographymentioning

confidence: 99%

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

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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Section: Bladder Ultrasonographymentioning

confidence: 99%

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

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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“…Studies evaluating the morphology of the lower urinary tract in diabetic rats reveal neuropathological findings as vacuolization of ganglion cells of the bladder wall, the presence of sympathetic neurons giants hipocromaticas ganglion cells, demyelination and axonal changes [21][22] .…”

Section: Discussionmentioning

confidence: 99%

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

Pegorare

Gonçalves²,

Suaid³

et al. 2014

Acta Cir. Bras.

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PURPOSE:To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS:Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS:The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION:Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea.

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“…Durch die pathophysiologischen Zusammenhänge lassen sich zwar urodynamische Phänomene erklären, jedoch sind diese für den Kontext der geriatrischen Urologie genauso wenig hilfreich wie Altersveränderungen im Detrusor mit Alterationen der Rezeptorverhältnisse im muskarinergen, adrenergen und purinergen System oder eine vermehrte Emp ndlichkeit auf Alpha-adrenerge Impulse [7,8,9,10,11].…”

Section: Vom Urologischen Symptom Zum Geriatrischen Syndromunclassified

Wer ältere Patienten urologisch behandeln will, muss umdenken

Wiedemann¹

2016

Uro-News

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The aging bladder: morphology and urodynamics

Cited by 78 publications

References 118 publications

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

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

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

Wer ältere Patienten urologisch behandeln will, muss umdenken

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