Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry

A prospective comparative study on bladder volume measurement with portable ultrasound scanner and CT simulator in pelvic tumor radiotherapy

OBJECTIVE

The consistency of bladder volume is very important in pelvic tumor radiotherapy, and portable bladder scanner is a promising device to measure bladder volume. The purpose of this study was to investigate whether the bladder volume of patients with pelvic tumor treated with radiotherapy can be accurately measured using the Meike Palm Bladder Scanner PBSV3.2 manufactured in China and the accuracy of its measurement under different influencing factors.

METHODS

A total of 165 patients with pelvic tumor undergoing radiotherapy were prospectively collected. The bladder volume was measured with PBSV3.2 before simulated localization. CT simulated localization was performed when the bladder volume was 200-400ml. The bladder volume was measured with PBSV3.2 immediately after localization and recorded. The bladder volume was then delineated on CT simulation images and recorded. To compare the consistency of CT simulation bladder volume and bladder volume measured by PBSV3.2. To investigate the accuracy of PBSV3.2 in different sex, age, treatment purpose, and bladder volume.

RESULTS

There was a significant positive correlation with bladder volume on CT and PBSV3.2 (r = 0.874; p < 0.001). The mean difference between CT measured values and PBSV3.2 was (-0.14 ± 50.17) ml. The results of the different variables showed that the overall mean of PBSV3.2 and CT measurements were statistically different in the age ≥ 65 years, bladder volumes > 400ml and ≤ 400ml groups (p = 0.028, 0.002, 0.001). There was no statistical significance between the remaining variables. The volume difference between PBSV3.2 measurement and CT was 12.87ml in male patients, which was larger than that in female patients 3.27ml. Pearson correlation analysis showed that the correlation coefficient was 0.473 for bladder volume greater than 400ml and 0.868 for bladder volume less than 400ml; the correlation coefficient of the other variables ranged from 0.802 to 0.893.

CONCLUSION

This is the first large-sample study to evaluate the accuracy of PBSV3.2 in a pelvic tumor radiotherapy population using the convenient bladder scanner PBSV3.2 made in China. PBSV3.2 provides an acceptable indicator for monitoring bladder volume in patients with pelvic radiotherapy. It is recommended to monitor bladder volume with PBSV3.2 when the planned bladder volume is 200-400ml. For male and patients ≥ 65 years old, at least two repeat measurements are required when using a bladder scanner and the volume should be corrected by using a modified feature to improve bladder volume consistency.

Naloxegol and Postoperative Urinary Retention: A Randomized Trial

Background: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo. Methods: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. Results: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. Conclusions: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.

Evaluation of a 3-dimensional ultrasound device for noninvasive measurement of urinary bladder volume in dogs

Background

The BladderScan Prime Plus (BPP; Verathon, Bothell, Washington) is an application‐specific, three‐dimensional ultrasound device used for human, point‐of‐care volumetry of the urinary bladder.

Objective

To estimate the BPP's accuracy, repeatability, and optimized settings for assessing urinary bladder volumes in dogs, a variable utilized in assessing micturition disorders.

Animals

Twenty‐four, client‐owned, healthy, male dogs presenting for routine examination.

Methods

Prospective examinations were conducted by an experienced ultrasonographer and a novice, selecting the BPP's “man” or “child” setting, and were compared to urine volume obtained by catheterization.

Results

Mean urine volume significantly varied by operator (P = .05), device setting (P < .001), and weight (P = .01); the “man” setting produced mean volumes nearer to catheterized volumes. The mean difference between BPP's “man” setting and catheterized volume was 0.88 mL, with maximal positive and negative disagreement of +23.2 mL to −55.3 mL (SD 19.0). Percent disagreement between BPP and catheterized volumes demonstrated a mean of −4.5%, with maximal positive and negative disagreement of +58.1% to −74.1% (SD 34.9). The experienced operator recorded volumes significantly (P = .05) higher than the novice, with difference in means of 3.2 mL. In dogs weighing >5.5 kg (n = 18/24), mean difference between BPP's “man” setting and catheterized measurements, regardless of operator, was not significant.

Conclusions

Although small magnitude interuser variability is present in BPP examinations, the device provides accurate, though imprecise quantification of bladder volume in canids weighing >5.5 kg.

The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy

AIMS AND OBJECTIVES

To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy.

BACKGROUND

It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies.

DESIGN

Randomised controlled study.

METHODS

A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder-training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation.

RESULTS

Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group.

CONCLUSIONS

Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy.

RELEVANCE TO CLINICAL PRACTICE

As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively.

Relationship between brain activity and voiding patterns in healthy preterm neonates

INTRODUCTION

It remains controversial as to whether the brain affects voiding control in preterm newborns. Constant bladder volume has previously been thought to induce bladder voiding in neonates, with no influence from the brain. Lately, there has been distinct evidence for an existing connection between the central nervous system and bladder voiding in preterm infants, as the voiding reflex arouses neonatal children. Video electroencephalography (EEG) is useful for recording bioelectrical activity of the cerebral cortex and exploring its relationship with voiding patterns in preterm neonates.

OBJECTIVE

The objective was to investigate the relationship between voiding patterns and brain activity in healthy preterm neonates by using video-EEG.

STUDY DESIGN

Forty-seven healthy preterm neonates (16 females) with a mean postconceptional age (PCA) of 34.1 ± 1.8 weeks were divided according to PCA into three groups: Group I (31-33 weeks, n = 13); Group II (33-35 weeks, n = 14); and Group III (35-37 weeks, n = 20). Video-EEG data from eight cortical regions were recorded from 08:00-12:00, along with 4-hour free voiding patterns and status at voiding (awake/sleep).

RESULTS

In Group I, the voiding frequency (VF) was significantly higher and the voiding volume (VV) was significantly lower than in the other groups. There were no significant differences in bladder capacity (BC), bladder capacity/birth weight (BC/BW), postvoiding residual/bladder capacity (PVR/BC), or urinary flow rate (UFR) among the three groups. The Fp1-T3 and Fp2-T4 lead amplitudes significantly differed in Group I and Group II at 5 s before (pre-5), during, and after voiding (post-5). The Fp2-C4 total and theta band lead amplitudes significantly differed across all urination states among the groups. There were no significant differences in electroencephalography frequency among the groups in any urination state.

DISCUSSION

There were no significant differences in BC, BC/BW, PVR/BC, or UFR among the three groups, indicating slow bladder function development in preterm neonates. In this study, the EEG amplitude changed in certain pairs of electrodes. These changes might indicate the degree of bladder sensor maturation along with an increasing PCA. This study further suggests that the brain changes in preterm neonates during quiet sleep voiding prominently occur in the right prefrontal cortex and central region.

CONCLUSIONS

In preterm neonates, bladder voiding during quiet sleep was accompanied by cortical arousal that might have emanated from a lower center.

The accuracy of three-dimensional bladder ultrasonography in determining the residual urinary volume compared with conventional catheterisation

Objective

To determine the accuracy of three-dimensional bladder ultrasonography (US, using the BVI 3000, Verathon, WA, USA) for determining the residual urinary volume, compared with the conventional catheterisation method.

Patients and methods

We conducted a cross-sectional study at day-care unit of a University hospital after obtaining approval from the Ethics Review Committee of the hospital. Thirty-four patients with lower urinary tract symptoms requiring cystometrography were included. The postvoid volume was measured by bladder US, with three readings taken, and then patient was catheterised using a 12-F Nelaton catheter to measure the urinary volume. The mean of the three readings was compared with the catheterisation volume.

Results

The mean (SD) urinary volumes by US and catheterisation were 261 (186) and 260 (175) mL, respectively, and the correlation (r²) was 0.97. There was no effect of age, gender or body mass index on the accuracy of bladder US, which was accurate even when the urinary volume was ⩽100 mL.

Conclusion

The bladder US estimate is as accurate as catheterisation for determining the postvoid residual urinary volume. Its accuracy was also comparable when the urinary volume is <100 mL, and there was no significant effect of age, gender and body mass index. This system could replace the more invasive catheterisation, and with excellent accuracy.

Serious periventricular white matter injury has a significant effect on the voiding pattern of preterm infants

AIM

To evaluate the effect of serious periventricular white matter injury (PWMI) on the voiding patterns of preterm infants.

METHODS

Free voiding was continuously observed for eight hours in 19 preterm infants with serious PWMI and 16 infants without PWMI. The infants had a gestational age of 32-35 weeks and a postnatal age of 9-15 days. Voiding frequency, voided volume, postvoid residual volume, empty voiding, awake voiding and interrupted voiding were recorded and compared between the two groups of infants.

RESULTS

The voiding frequency ((5.1 ± 1.0) vs. (7.0 ± 1.1)), awake voiding percentage ((23 ± 11)% vs. (42 ± 7)%) and empty voiding percentage (lower quartile = 16% vs. 28%, median = 20% vs. 33%, upper quartile = 28% vs. 40%) were significantly lower, while the voided volume ((19.9 ± 6.6) mL vs.(15.9 ± 5.3) mL)and postvoid residual volume (lower quartile = 1 mL. vs. 0 mL., median = 3 mL. vs. 2 mL., upper quartile = 3 mL. vs. 2 mL.) were significantly higher in the injured preterm infants, compared with the healthy infants (p < 0.05).

CONCLUSION

Serious PWMI has a significant effect on the voiding pattern of preterm infants, and the senior nerve centre plays a role in the voiding reflex of preterm infants.