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Shahait M, Usamentiaga R, Tong Y, Sandberg A, Lee DI, Udupa JK, Torigian DA. MRI-based radiomic features of the urinary bladder wall identify patients with moderate-to-severe international prostate symptom score. World J Urol 2024; 42:375. [PMID: 38872048 DOI: 10.1007/s00345-024-05081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The International Prostate Symptom Score (IPSS) is a patient-reported measurement to assess the lower urinary tract symptoms of bladder outlet obstruction. Bladder outlet obstruction induces molecular and morphological alterations in the urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, and nerves. We sought to analyze MRI-based radiomics features of the urinary bladder wall and their association with IPSS. METHOD In this retrospective study, 87 patients who had pelvic MRI scans were identified. A biomarker discovery approach based on the optimal biomarker (OBM) method was used to extract features of the bladder wall from MR images, including morphological, intensity-based, and texture-based features, along with clinical variables. Mathematical models were created using subsets of features and evaluated based on their ability to discriminate between low and moderate-to-severe IPSS (less than 8 vs. equal to or greater than 8). RESULTS Of the 7,666 features per patient, four highest-ranking optimal features were derived (all texture-based features), which provided a classification accuracy of 0.80 with a sensitivity, specificity, and area under the receiver operating characteristic curve of 0.81, 0.81, and 0.87, respectively. CONCLUSION A highly independent set of urinary bladder wall features derived from MRI scans were able to discriminate between patients with low vs. moderate-to-severe IPSS with accuracy of 80%. Such differences in MRI-based properties of the bladder wall in patients with varying IPSS's might reflect differences in underlying molecular and morphological alterations that occur in the setting of chronic bladder outlet obstruction.
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Affiliation(s)
| | - Ruben Usamentiaga
- Department of Computer Science and Engineering, University of Oviedo, Gijon, Spain
| | - Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3710 Hamilton Walk, Goddard Building, 6th Floor, Rm 601W, Philadelphia, PA, 19104, USA
| | - Alex Sandberg
- Temple Medical School, Temple University, Philadelphia, PA, USA
| | - David I Lee
- Department of Urology, University of California Irvine, Irvine, CA, USA
| | - Jayaram K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3710 Hamilton Walk, Goddard Building, 6th Floor, Rm 601W, Philadelphia, PA, 19104, USA
| | - Drew A Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 3710 Hamilton Walk, Goddard Building, 6th Floor, Rm 601W, Philadelphia, PA, 19104, USA.
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Bladder wall thickness measured by CT can predict bladder outlet obstruction in men: a retrospective cohort study. Int Urol Nephrol 2023; 55:43-49. [PMID: 36103042 DOI: 10.1007/s11255-022-03361-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/01/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate whether bladder wall thickness (BWT) measured by CT can be used to predict bladder outlet obstruction in men with low urinary tract symptoms (LUTS). METHODS From 2015 to 2018, a total of 120 men with lower urinary tract symptoms who underwent both urodynamic studies and CT tests of the lower abdomen or pelvis were involved. Bladder wall thickness values were measured by CT scanning. RESULTS Based on the urodynamic studies, 120 men were categorized into two groups, including 70/120 men (58.3%) in the bladder outlet obstruction (BOO) group and 50/120 men (41.7%) in the non-BOO group. The mean BWT was thicker in the BOO group than in the non-BOO group (3.87 vs. 2.75 mm, p < 0.001). The mean maximum bladder capacity (MBC) was lower in the BOO group than in the non-BOO group (263.42 vs. 308.96 ml, p < 0.001). The mean detrusor pressure at maximum urinary flow rate (PdetQmax) was higher in the patients in the BOO group than in those in the non-BOO group (102.28 vs. 49.25 cmH2O, p < 0.001). The ROC curve showed that BWT was a good predictor with an AUC of 0.855 (95% CI 0.785-0.924, p < 0.001). At the cutoff value of 3.20 mm, the predictive sensitivity of BWT for BOO was 72.9%, and the specificity was 90%. CONCLUSION Increased bladder wall thickness was correlated with bladder outlet obstruction in men with LUTS. Bladder wall thickness measured by CT scans may be a noninvasive parameter to predict bladder outlet obstruction in men with LUTS.
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Khosla L, Codelia-Anjum A, Sze C, Martinez Diaz S, Zorn KC, Bhojani N, Elterman D, Chughtai B. Use of the penile cuff test to diagnose bladder outlet obstruction: A systematic review and meta-analysis. Low Urin Tract Symptoms 2022; 14:318-328. [PMID: 35716000 DOI: 10.1111/luts.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Among noninvasive modalities for assessing bladder outlet obstruction (BOO), the penile cuff test (PCT) is the most used in clinical practice. The purpose of this review was to evaluate the performance of PCT in diagnosing and managing BOO. MATERIALS AND METHODS PubMed, Scopus, CINAHL, Embase, Cochrane Library, and Web of Science were searched for studies investigating use of PCT for BOO. Studies evaluating diagnostic parameters, inter-observer agreements, or treatment outcomes using PCT were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed (PROSPERO ID: CRD42022300047). A proportional meta-analysis was done for diagnostic accuracy proportions. The Egger's and the Begg-Mazumdar rank-correlation tests were used to assess publication bias. Risk of bias was assessed using the Gradings of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. RESULTS Of the 272 articles retrieved, 17 were included in qualitative synthesis and meta-analysis was performed on five studies (comprising 448 patients). Two studies evaluating inter-observer agreement demonstrated 95% agreement and five studies evaluating procedures reported a 66%-80% surgical success rate on obstructed patients using PCT. From the proportional meta-analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.85 (95% CI 0.71-0.95) 0.78 (95% CI 0.67-0.87), 0.74 (95% CI 0.52-0.91), and 0.87 (95% CI 0.73-0.96), respectively. Publication bias was noted for PPV but not for sensitivity, specificity, or NPV. Based on the GRADE criteria, there were two low, six moderate, and nine high-quality studies. CONCLUSIONS PCT performs sufficiently in diagnosing and managing BOO. However, due to variability in obstruction criteria assessment, more studies comparing diagnostic criteria are warranted.
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Affiliation(s)
- Lakshay Khosla
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | | | - Christina Sze
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | | | - Kevin C Zorn
- Division of Urology, Department of Surgery, University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
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Valentini FA, Nelson PP. Mathematical Modeling and Uroflow-Based Nomograms in Voiding Dysfunction Evaluation: Ready for Prime Time? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Harding C, Rosier PF, Drake MJ, Valentini F, Nelson PP, Goping I, Gammie A. What research is needed to validate new urodynamic methods? ICI-RS2017. Neurourol Urodyn 2018; 37:S32-S37. [DOI: 10.1002/nau.23561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/22/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher Harding
- Department of Urology; Newcastle upon Tyne Hospitals NHS Foundation Trust; Heaton Newcastle UK
| | | | | | | | | | - Ing Goping
- Laborie Medical Technologies; Mississauga Ontario Canada
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de Almeida JCM, D'Ancona CAL, Bassani JWM. Minimally invasive measurement of vesical pressure for diagnosis of infravesical obstruction. Neurourol Urodyn 2017; 37:849-853. [PMID: 28782261 DOI: 10.1002/nau.23366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/03/2017] [Indexed: 11/11/2022]
Abstract
AIMS This study was focused on the clinical test of an improved and portable version of a previously described urethral connector (UC), designed for minimally invasive measurement of vesical pressure and diagnosis of infravesical obstruction in men. METHODS The conventional pressure-flow study (PFS) and the test with the new version of UC were applied to individuals reporting lower urinary tract symptoms (LUTS), who were then classified as obstructed or non-obstructed/equivocal based on the bladder outlet obstruction index (BOOI) from PFS data. Two-way analysis of variance was used to compare the values of urine flow rate and vesical pressure between methods and diagnoses. RESULTS Vesical pressure and urine flow values were not significantly different between methods (P > 0.05), while the former was greater in the group classified as obstructed. CONCLUSION The present results showed that the UC test can support the diagnosis of infravesical obstruction in a comparable way as that of the conventional urodynamic method, however with the advantages of simplicity and minimal invasiveness, having thus the potential to be an alternative method for long term follow-up of individuals reporting LUTS.
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Affiliation(s)
- João C M de Almeida
- Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, Campinas, Brazil
| | - Carlos A L D'Ancona
- Division of Urology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - José W M Bassani
- Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, Campinas, Brazil.,Center for Biomedical Engineering, University of Campinas, Campinas, Brazil
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Han JH, Yu HS, Lee JY, Kim J, Kang DH, Kwon JK, Choi YD, Cho KS. Simple Modification of the Bladder Outlet Obstruction Index for Better Prediction of Endoscopically-Proven Prostatic Obstruction: A Preliminary Study. PLoS One 2015; 10:e0141745. [PMID: 26505196 PMCID: PMC4624432 DOI: 10.1371/journal.pone.0141745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/11/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose The bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO. Materials and Methods We retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax. Results Ultimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05). Conclusions The change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH.
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Affiliation(s)
- Jang Hee Han
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joohan Kim
- Department of Mechanical Engineering, Seoul National University of Science & Technology, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Yangpyeong Health Center, Yangpyeong, Korea
| | - Jong Kyu Kwon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Kazemeyni SM, Otroj E, Mehraban D, Naderi GH, Ghadiri A, Jafari M. The role of noninvasive penile cuff test in patients with bladder outlet obstruction. Korean J Urol 2015; 56:722-8. [PMID: 26495074 PMCID: PMC4610900 DOI: 10.4111/kju.2015.56.10.722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to compare the penile cuff test (PCT) and standard pressure-flow study (PFS) in patients with bladder outlet obstruction. MATERIALS AND METHODS A total of 58 male patients with moderate to severe lower urinary tract symptoms (LUTS) were selected. Seven patients were excluded; thus, 51 patients were finally enrolled. Each of the patients underwent a PCT and a subsequent PFS. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated. Chi-square and Fisher exact test were used to evaluate relationships between PCT results and maximal urine flow (Qmax); a p<0.05 was considered statistically significant. RESULTS The mean (±standard deviation) age of the study group was 65.5±10.4 years. Overall, by use of the PCT, 24 patients were diagnosed as being obstructed and 27 patients as unobstructed. At the subsequent PFS, 16 of the 24 patients diagnosed as obstructed by the PCT were confirmed to be obstructed, 4 were diagnosed as unobstructed, and the remaining 4 patients appeared equivocal. Of the 27 patients shown to be unobstructed by the PCT, 25 were confirmed to not be obstructed by PFS, with 13 equivocal and 12 unobstructed. Two patients were diagnosed as being obstructed. For detecting obstruction, the PCT showed an SE of 88.9% and an SP of 75.7%. The PPV was 66.7% and the NPV was 93%. CONCLUSIONS The PCT is a beneficial test for evaluating patients with LUTS. In particular, this instrument has an acceptable ability to reject obstruction caused by benign prostatic hyperplasia.
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Affiliation(s)
| | - Ehsan Otroj
- Department of Urology, Tehran University of Medical Science, Tehran, Iran
| | - Darab Mehraban
- Department of Urology, Tehran University of Medical Science, Tehran, Iran
| | | | - Afsoon Ghadiri
- Department of Urology, Tehran University of Medical Science, Tehran, Iran
| | - Mahdi Jafari
- Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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