Measurement of bladder compliance can be standardized by a dimensionless number: clinical perspective (original) (raw)
Neurourology and Urodynamics, 2013
Background: There is an agreement to use simple formulae (expected bladder capacity and other age based linear formulae) as bladder capacity benchmark. But real normal child's bladder capacity is unknown. Aims: To offer a systematic review of children's normal bladder capacity, to measure children's normal maximum voided volumes (MVVs), to construct models of MVVs and to compare them with the usual formulae. Methods: Computerized, manual and grey literature were reviewed until February 2013. Epidemiological, observational, transversal, multicenter study. A consecutive sample of healthy children aged 5-14 years, attending Primary Care centres with no urologic abnormality were selected. Participants filled-in a 3-day frequency-volume chart. Variables were MVVs: maximum of 24 hr, nocturnal, and daytime maximum voided volumes. Factors: diuresis and its daytime and nighttime fractions; bodymeasure data; and gender. The consecutive steps method was used in a multivariate regression model. Results: Twelve articles accomplished systematic review's criteria. Five hundred and fourteen cases were analysed. Three models, one for each of the MVVs, were built. All of them were better adjusted to exponential equations. Diuresis (not age) was the most significant factor. There was poor agreement between MVVs and usual formulae. Nocturnal and daytime maximum voided volumes depend on several factors and are different. Conclusions: Nocturnal and daytime maximum voided volumes should be used with different meanings in clinical setting. Diuresis is the main factor for bladder capacity. This is the first model for benchmarking normal MVVs with diuresis as its main factor. Current formulae are not suitable for clinical use. Neurourol. Urodynam. # 2013 Wiley Periodicals, Inc.
Neurourology and Urodynamics, 2007
Aims: To study the effects of age and 24-h volume (V 24 ) on bladder diary measurements of voiding frequency (F 24 ) and functional bladder capacity (FBC) from an asymptomatic female population. Also, to use these data to develop clinical reference values. (We use FBC as a generic term for bladder diary volume-per-void measurements.) Materials and Methods: Computer-processed 3-day bladder diaries were collected from 161 females (median age: 46.6 years; range ¼ 19.6-81.8 years) claiming no urological symptoms, previous pelvic surgery and diseases and medications effecting urologic function. Regression analysis was used to investigate relationships among age, FBC and V 24 . Results: Both FBC and F 24 increase as V 24 increases (P < 0.0005). With aging, F 24 increases (P ¼ 0.026) and FBC may decrease slightly (P ¼ 0.02-0.08). There is a concave downward, curvilinear relationship between age and V 24 . We used multiple regression to generate tables of FBC and F 24 ''normal limits'' adjusted for these simultaneous influences of V 24 and age. Removing their relationships to age reduces the variability of FBC and F 24 reference values by 50% and 20%, respectively. Conclusions: Our finding, supported by others, that, with increasing V 24 , FBC increases more than F 24 suggests an adaptive mechanism that adjusts FBC to urine production to minimize changes in voiding frequency. We illustrate adjustment of reference values for age and V 24 by calculating traditional clinical ''normal limits.'' However, the probable large overlap between ''normal'' and ''abnormal'' suggests that it may be more useful to report bladder diary measurements as reference population percentiles rather than to designate them ''normal '' or ''abnormal.'' Neurourol. Urodynam. 26:341-349, 2007. ß 2007 Abbreviations: BDRT, Bladder Diary Research Team; DO, detrusor overactivity; F 24 , 24-hr voiding frequency; FBC, functional bladder capacity; P 24 , 24-hr urine production rate; UI, urge incontinence; V 24 , 24-hr urine volume; V avg , average volume-per-void; V min , minimum volume-per-void; V max , maximum volume-pervoid; V rng , range of voided volumes V max minus V min . Institutions at which work was performed:
International Neurourology Journal, 2022
Purpose: To identify more accurate predictors of upper urinary tract dilatation (UUTD) in neurogenic bladder (NB) children, we studied the relationship among urodynamic parameters at different bladder filling stages, detrusor leak point pressure (DLPP) and UUTD. Methods: A total of 158 children (3-16 years) with NB were included and then divided into 2 groups according to whether their NB diagnosis was complicated with UUTD: the UUTD group (39 patients) and those without UUTD group (control group, 119 patients). The bladder filling phase was divided into 3 equal parts: the early, middle, and end filling stages. The bladder compliance (BC) and detrusor pressure (△Pdet) at each phase and DLPP at the end filling stage were recorded. Results: A BC < 8 mL/cm H2O both in the middle and end stages is more specific than a BC < 9 mL/cm H2O in the end stage (72%, 73%, vs. 66%), and △Pdet > 8 cm H2O in the early stage, 20 cm H2O in the middle stage and 25 cm H2O in the end stage are more sensitive than △Pdet > 40 cm H2O in the end stage (82%, 85%, 85%, vs. 49%). A DLPP cutoff value of 20 cm H2O showed higher sensitivity for predicting UUTD than 40 cm H2O. Conclusions: Low BC and a high △Pdet in the middle and end filling stages are more accurate factors than classic indicators for predicting UUTD. In addition, a DLPP value of > 20 cm H2O in the end bladder filling stage shows high sensitivity.
The development of the ICIQ‐UAB: A patient reported outcome measure for underactive bladder
Neurourology and Urodynamics, 2019
Aims: To present the development of the International Consultation on Incontinence Questionnaire-underactive bladder (ICIQ-UAB) as the first patient reported outcome measure for the assessment of the symptoms and impact on the health-related quality of life of UAB developed in-line with the Food and Drug Administration Guidance for Industry. Methods: Draft items were developed following 44 semi-structured concept elicitation interviews in the UK and refined using 36 cognitive interviews. A pilot study was designed to assess the draft ICIQ-UAB's initial psychometric properties with 54 patients recruited from European hospitals. Further concept elicitation interviews were also carried out with 11 patients in the US and 10 patients in Japan. All participants had a prior urodynamic diagnosis of detrusor underactivity. Results: The cognitive interviews confirmed the initial items to be understood and interpreted as intended. Pilot testing showed that both internal consistency (Cronbach's α ≥ 0.85) and test-retest reliability (stable patients; intraclass correlation coefficient ≥ 0.88) were high.
PloS one, 2017
The objective of this study is to assess correlation between bladder wall mechanical properties obtained by ultrasound bladder vibrometry (UBV) and urodynamic study (UDS) measurements in a group of patients undergoing clinical UDS procedure. Concurrent UBV and UDS were performed on 70 patients with neurogenic bladders (56 male and 14 female). Bladder wall mechanical properties measured by UBV at different filling volumes were correlated with recorded detrusor pressure (Pdet) values. Mean, median and standard deviation of correlation values were calculated and the significance of these observations was tested. Bladder wall mechanical properties obtained by UBV as group velocity squared and elasticity showed high correlations with Pdet measured at different volumes (median correlation 0.73, CI: 0.64-0.80 and 0.72, CI: 0.56-0.82 respectively). The correlation of group velocity squared and elasticity with Pdet were both significantly higher than 0.5. The results of this study suggest th...
Bladder pressure monitoring during intermittent catheterization: A comparison of gauges and methods
Neurourology and Urodynamics, 2003
Aims: We previously have investigated a technique for serial bladder pressure measurements in patients with spinal cord injury (SCI) using intermittent catheterization. In the current study, we compared an FDA-approved digital gauge with the previously studied analog gauge and studied the e¡ects of hydrostatic pressure di¡erences. Methods: Either a digital or an analog pressure gauge was attached to each subject's catheter just before bladder catheterization. Both immediate and stable pressures were recorded. The bladder was then drained until nearly empty and pressure was again recorded (almost empty bladder pressure). Detrusor pressure was estimated as full minus almost empty bladder pressure. Bladder pressures greater than 40 cm H 2 O were presumed to represent bladder contractions. To investigate the e¡ects of hydrostatic pressure, additional measurements, adjusting the level of the air^urine meniscus, were obtained in three subjects. Results: Recordings were made from nine SCI subjects using both gauges. Estimates of detrusor pressure, with and without bladder contractions, and associated bladder volumes, were not signi¢cantly di¡erent between digital and analog gauges. In the absence of bladder contractions, detrusor pressure with the meniscus at the end of the catheter (5 AE 1 cm H 2 O) was signi¢cantly lower than that recorded with no adjustment of the urine meniscus (12 AE 1 cm H 2 O). Conclusions: Standardizing measurement techniques to equalize hydrostatic pressures should facilitate reliable estimates of detrusor pressure. Frequent monitoring of bladder pressure using this technique may assist with the urological care of SCI patients. Neurourol. Urodynam. 22: 250^254,
Urodynamic Characterization of Incontinence in the Elderly by Bladder Volume
The Journal of Urology, 1983
Incontinence in the elderly patient usually is of the urgency pattern owing to inappropriate detrusor contraction often termed detrusor instability. We herein describe a bladder volume-based method of urodynamic assessment that may help to characterize subsets of incontinent patients with detrusor instability. The conventional parameters of flow, pressure and electromyography are more difficult to measure and may be less appropriate for selection of therapy.
Estimating Normal Bladder Capacity in Children
The Journal of Urology, 1997
Purpose: An accurate estimation of normal bladder capacity can be helpful in evaluating the patient with genitourinary disease and in interpreting urodynamic data. Prior studies have provided initial estimates. We propose 2 new equations that are practical, easy to use and more accurate than those previously published.
European Urology, 2006
e u r o p e a n u r o l o g y 4 9 ( 2 0 0 6 ) 1 0 7 9 -1 0 8 6 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objectives: The purpose of this study was to evaluate the validity and responsiveness of a global measure for overactive bladder (OAB), the Patient Perception of Bladder Condition (PPBC). Methods: Post-hoc analyses were conducted on two 12-wk clinical trials for OAB (Study 1: n = 865; Study 2: n = 520). In addition to the PPBC, patients completed two condition-specific health-related quality of life (HRQL) measures, the Overactive Bladder Questionnaire (OAB-q) and King's Health Questionnaire (KHQ), and bladder diaries at baseline and 12 wk. Validity of the PPBC was evaluated through correlations with baseline diaries, OAB-q, and KHQ. The responsiveness of the PPBC was evaluated using correlations and general linear models to assess the degree of association between change in PPBC and change in the diaries, OAB-q, and KHQ. Results: Both samples were primarily women and white with mean ages of 61.0 and 58.8 yr. The majority of patients were incontinent (75.3% and 80.4%) with the greatest proportion of patients indicating that they had ''moderate problems'' (47.5% and 51.2%) on the PPBC at baseline. Significant correlations were present at baseline and among change scores between the PPBC and the bladder diaries ( p < 0.001), OAB-q ( p < 0.001), and KHQ ( p < 0.01). In both studies, patients with major PPBC improvement had significantly greater reductions in frequency, urgency episodes, incontinence episodes, and Symptom Bother and significantly greater improvements in HRQL than patients with only a minor PPBC improvement. Conclusion: The PPBC, a global patient-reported measure of bladder condition, demonstrated good construct validity and responsiveness to change. These findings support the use of the PPBC as a global assessment of bladder condition among patients with OAB.
Journal of Pediatric Urology, 2016
Introduction: Objective evaluation of bladder capacity (BC) in children with lower urinary tract symptoms (LUTS) is important for recognizing types of bladder dysfunction. Bladder capacity is evaluated from 48-hour frequency/volume (48-h F/V) charts or by uroflowmetry with ultrasound post-void assessment. There are limited data on the reliability of both methods of assessment in children. Objective: The aim of the study was to compare two modalities of assessment, (F/V chart and uroflowmetry) in cohorts of children with bladder dysfunctions. Study design: Maximum bladder capacity (MBC) obtained from 48-h F/V charts was compared with volumes calculated from uroflowmetry in a cohort of 86 children with different bladder dysfunctions. The BC obtained by the two modalities was compared for the three most frequent subtypes of bladder dysfunction: monosymptomatic nocturnal enuresis (MNE), overactive bladder (OAB), and dysfunctional voiding (DV). Considering a 48-h F/V chart as standard, the sensitivity, specificity, negative and positive predictive values of uroflowmetry measurements were calculated for detecting low bladder capacity. Results: The mean maximal bladder capacity (188±99.42 ml) obtained from home 48-h F/V chart measurement was 17 ml lower than the mean value obtained from uroflowmetry (205±112.11 ml) (P=0.58). The differences between bladder capacities estimated by 48-h F/V chart and uroflowmetry for subjects were not significant (Fig. 1). Concordance between 48-h F/V chart and uroflowmetry categorization of BC was present in 64 (74%) subjects. The sensitivity and specificity of uroflowmetry, in comparison with 48-h F/V chart evaluation, for recognizing low bladder capacity were 75.5% and 73.17%. The sensitivity and specificity for the different types of LUTS achieved 68.42% and 58.83% for OAB, 80% and 83% for MNE, and 50% and 83.3% for DV. Discussion: According to the International Children's Continence Society, the management of MNE in children can be made without uroflowmetry. History and MBC evaluation by 48-h F/V charts yields sufficient information. Nevertheless, in situations where F/V charts are unreliable or unavailable, uroflowmetry can be used as an