Ultrasound assessment of bladder wall thickness as a screening test for detrusor instability

Abou-Gamrah, Amgad; Fawzy, Mounir; Sammour, Hazem; Tadros, Sherif

doi:10.1007/s00404-013-3092-5

Cited by 16 publications

(11 citation statements)

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“…These findings agree with those of Abou-Gamrah et al [10] who reported a 90% sensitivity and a 78% specificity. Tangal et al [11] who performed their study on children reported lower values (67% sensitivity and 80% specificity).…”

Section: Discussionsupporting

confidence: 95%

Accuracy of ultrasound-measured bladder wall thickness for the diagnosis of detrusor overactivity

Ahmed

Khaled

et al. 2015

African Journal of Urology

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Objectives: To evaluate the usefulness and accuracy of ultrasound-measured urinary bladder wall thickness (BWT) in the diagnosis of detrusor overactivity (DO). Subjects and methods: Patients who had undergone urodynamic testing due to irritative lower urinary tract symptoms (LUTS) were evaluated for participation in this study. All patients were submitted to thorough history taking, general physical and genital examination, urine analysis, urine culture, blood chemistry, uroflowmetry and abdominal ultrasonography. The patients were categorized into 2 groups according to the urodynamic diagnosis: group 1 consisted of 62 patients with documented DO and group 2 of 36 patients with no evidence of DO (controls). Ultrasound measurement of BWT was performed with the bladder filled with 50 ml of normal saline solution. The data were analyzed and the results of both groups were compared using suitable analytical tests. Results: The age and gender distribution were comparable. Urgency was the main symptom in both groups. Mean BWT measured by ultrasound was significantly higher in group 1 than in group 2 (5.54 ± 1.95 mm versus 3.22 ± 0.84 mm, p < 0.001) with an overall sensitivity of 91.9% in predicting DO at a cutoff point of 3.75 mm. Conclusions: Measurement of BWT using ultrasonography is a sensitive diagnostic test for the prediction of DO. Further studies on a larger number of patients are required to validate these results.

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Section: Discussionsupporting

confidence: 95%

Accuracy of ultrasound-measured bladder wall thickness for the diagnosis of detrusor overactivity

Ahmed

Khaled

et al. 2015

African Journal of Urology

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“…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…”

Section: Placing the Results In The Context Of Other Researchmentioning

confidence: 99%

“…49,51,54,57,72,117 Our study is the most conclusively negative study of the diagnostic value of bladder ultrasonography to date.…”

Section: Diagnostic Accuracy Of Bwt Via Bladder Ultrasonography In Thmentioning

confidence: 99%

“…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.…”

Section: Diagnostic Accuracy Of Bwt Via Bladder Ultrasonography In Thmentioning

confidence: 99%

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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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“…For a mean BWT cut-off of 5 mm, the specificity was reported to be 89% (95% CI 79-96) with a sensitivity of 84% (95% CI 76-90). 16 We identified further studies [19][20][21][22][23][24][25][26][27][28][29][30] which had investigated the relation between BWT measured by ultrasonography and DO, with estimates of sensitivity, specificity and AUC for bladder ultrasound varying from 37-91%, 61-97% and 0.61-0.91, respectively. 8 The published studies are mostly from a single centre (often tertiary) and there are multiple reasons to have concerns about the validity and applicability of findings.…”

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

Ultrasound bladder wall thickness and detrusor overactivity: a multicentre test accuracy study

Latthe

Middleton

Rachaneni

et al. 2017

BJOG

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Ultrasound assessment of bladder wall thickness as a screening test for detrusor instability

Abstract: In women with lower urinary tract symptom, transvaginal ultrasounds measured mean BWT seems to be an effective non invasive diagnostic tool for prediction of OAB.

Cited by 16 publications

References 10 publications

Accuracy of ultrasound-measured bladder wall thickness for the diagnosis of detrusor overactivity

Accuracy of ultrasound-measured bladder wall thickness for the diagnosis of detrusor overactivity

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

Ultrasound bladder wall thickness and detrusor overactivity: a multicentre test accuracy study

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