Bladder Wall Thickness on Ultrasonographic Cystourethrography

Yang, Jenn Ming; Huang, Wen Chen

doi:10.7863/jum.2003.22.8.777

Cited by 58 publications

(36 citation statements)

References 17 publications

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“…Target structure of the toxin is the detrusor muscle, as its main mechanism of action is at the neuromuscular junction [10,11]. However, detrusor thickness is variable and depends on several factors such as gender, age, bladder filling volume and the presence of neurogenic lesion or obstruction [12,13]. Although injection is performed under cystoscopic guidance, injection depth can only be estimated by the surgeon.…”

Section: Introductionmentioning

confidence: 99%

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

et al. 2009

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OBJECTIVES: Although botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscarinic drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI). METHODS: Six patients with NDO were recruited. Three of six patients received 300 U of BoNT/A + contrast agent distributed over 30 injection sites (group 1). The other three patients received 300 U of BoNT/A + contrast agent distributed over 10 injection sites (group 2). Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated. RESULTS: In all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor). In both groups there was a similar distribution of the contrast medium in the target area. A mean of 33.3 and 25.3% of the total detrusor volume was covered in group 1 and 2, respectively. Six weeks after injection, five of six patients were continent and showed no detrusor overactivity in the urodynamic follow-up. No systemic side effects were observed. CONCLUSIONS: Our results provide morphological arguments that the currently used injection techniques are appropriate and safe.A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance Abstract ObjectivesAlthough botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscaric drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI). MethodsSix patients with NDO were recruited. 3 of 6 patients received 300 units of BoNT/A + contrast agent distributed over 30 injection sites (Group 1). The other 3 patients received 300 units of BoNT-A + contrast agent distributed over 10 injection sites (Group 2).Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated. ResultsIn all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor).In both groups there was a similar distribution of the contrast medium in the target area.A mean of 33.3% and 25.3% of th...

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Section: Introductionmentioning

confidence: 99%

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

et al. 2009

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“…This is consistent with the literature evaluating BW thickness at urine volumes up to 250 cm 3 , 12,17 where wall thickness was inversely correlated with urine volume and intravesical pressure. 13,15 This suggests that, for the purposes of generating a BW structure for DVH calculations and dose reconstruction, it would be inaccurate to apply a generic uniform contraction (such as 2.5 mm) to a group of patients. Furthermore, it would also be inaccurate to apply a constant, but patient-specific contraction in multiple images when bladder filling is variable.…”

Section: Discussionmentioning

confidence: 99%

“…However, large variations in BW thickness between patients have been noted, 12,13 and wall thickness has also been inversely related to the volume of urine contained within the bladder. [13][14][15][16] The specifics of that inverse relationship seem to vary for different filling volumes however, 12,17,18 and it has been reported that the volume of the wall actually increases slightly with increasing urine volume owing to the increased blood perfusion in the detrusor muscle at larger urine volumes. 9,19 To facilitate dose reconstruction to the hollow BW, the objective of this study was to evaluate the use of a uniform contraction from the OB surface to delineate the IB surface under variable bladder filling conditions employing: a generic contraction (2.5 mm); a constant, patient-specific contraction; a variable contraction based on patient-specific constant wall volume; and a variable contraction based on patient-specific variable wall volume.…”

Section: Introductionmentioning

confidence: 99%

Delineating the inner bladder surface using uniform contractions from the outer surface under variable bladder filling conditions

Rosewall

Bayley

Catton

et al. 2015

BJR

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Objective: To evaluate the methods to delineate the inner bladder (IB) surface using a uniform contraction from the outer bladder (OB) surface, assuming the bladder wall (BW) is either of constant thickness, constant volume or variable volume. Methods: 14 prostate intensity-modulated radiotherapy patients with 2 planning CTs were identified. For both CTs, OB was delineated using model-based segmentation. IB was delineated manually. Then, using uniform contractions from OB, the position of IB was approximated using a: 2.5-mm contraction, patient-specific contraction, patientspecific constant wall volume method and variable wall volume method. The structures created using those strategies were compared against the manual IB contours using geometric and dosimetric indices. Results: In the presence of variable bladder filling, use of a generic or patient-specific constant contraction resulted in a significant overestimation of IB volume (112 and 113 cm 3 , respectively; p , 0.001) that was inversely correlated with the difference in urine volume between the scans (R 2 . 0.86). Mean differences across 95% of IB surfaces were #2 mm for methods using either constant or variable wall volume. Mean dose-volume histogram (DVH) differences were ,1 cm 3 across the whole BW DVH when using the method that assumed a variable wall volume. Conclusion:The variable volume BW model provided the best approximation of the IB surface position under varying filling conditions, based on geometric and dosimetric indices. Advances in knowledge: Use of the equation derived in this research provides a quick and accurate method to delineate the hollow BW on serial imaging for the purposes of dose reconstruction.

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“…The other possible reason is that the renal parenchyma and perihilar adipose tissue surrounding the renal pelvis may act as a barrier against early spread. 23,24 One study reported an overall better prognosis of renal pelvic tumour than ureteral tumour; the authors suggested the protective role of thick renal parenchyma against local tumour spread. 12 Another reason is adjuvant chemotherapy, which is usually undertaken in UUTUC above T2, according to the medical insurance policy in Korea.…”

Section: Cuaj • April 2013 • Volume 7 Issues 3-4 E218mentioning

confidence: 99%

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

Hwang

Jung

Nam

et al. 2013

CUAJ

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Introduction:We assess the impact of traditional prognostic factors, tumour location, degree of hydronephrosis and diabetes mellitus (DM) on the survival of patients treated for upper urinary tract urothelial carcinoma (UUTUC). Methods: From January 2004 to March 2010, we analyzed data from 114 patients with UUTUC who underwent nephroureterectomy with a bladder cuff excision. Median patient age was 71 years and median follow-up was 26.5 months. The influence of traditional prognostic factors, including DM, tumour stage, grade, location and degree of hydronephrosis, on recurrence-free survival (RFS) rates were analyzed using Kaplan-Meier analysis and Cox proportional hazards regression model. Results: Among 61 renal pelvis and 53 ureteral tumour cases, recurrence was identified in 71 cases (62.3%). Kaplan-Meier analysis showed that degree of hydronephrosis was associated with RFS (p = 0.001). DM and degree of hydronephrosis were independent factors for RFS in Cox proportional regression analysis (HR=1.8 CI: 1.01-3.55, p = 0.04), (HR=3.7, CI: 2.0-6.5, p = 0.001). All patients with ureteral tumour had no worse prognosis than those with renal pelvis tumour , but the pT2 patients with ureteral tumour had a worse prognosis than those with renal pelvis tumour with a median RFS of 9 months (range: 2.6-15.3 months) and 29 months (range: 8.0-13.2 months), respectively (p = 0.028). Conclusions: Tumour location is not a factor influencing RFS, except in the pT2 stage. However, severe hydronephrosis is associated with a higher recurrence in UUTUC. Also, DM is related to disease recurrence. Further prospective studies are needed to establish the prognostic significance of DM in large populations. IntroductionUpper urinary tract urothelial carcinoma (UUTUC), including renal pelvic and ureteral cancer, is relatively rare, constituting 5% of all urinary tract urothelial carcinoma cases. 1Urothelial carcinoma of the renal pelvis is 3 to 4 times more common than ureteral urothelial carcinoma. 2,3T stage, tumour grade and lymphovascular invasion are thought to be prognostic factors for UUTUC. [4][5][6][7] Of these factors, the most important is the pathologic T stage. Although computed tomography (CT) has been applied to determine the preoperative T stage in UUTUC, the accuracy of this prediction is poor, making it difficult to predict the prognosis of patients with UUTUC. 8 The impact of tumour localization on prognosis has been debated. 6,9,10 In some reports, ureteral urothelial carcinoma had a worse prognosis than renal pelvic urothelial carcinoma.10-12 Generally, ureteral urothelial carcinoma causes gradual ureteral obstruction, resulting in hydronephrosis. This continuous obstruction may cause higher hydronephrosis grade and impairment of renal function. Therefore, severe degree of hydronephrosis may be associated with late detection of UUTUC and late treatment.Diabetes mellitus (DM) is a chronic metabolic disease. Evidence indicates that DM is influential in the treatment outcomes of malignancies.13 Several studies ...

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Bladder Wall Thickness on Ultrasonographic Cystourethrography

Abstract: Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both.

Cited by 58 publications

References 17 publications

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

Delineating the inner bladder surface using uniform contractions from the outer surface under variable bladder filling conditions

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

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