|Year : 2010 | Volume
| Issue : 2 | Page : 319-320
Bladder wall thickness for the assessment of voiding dysfunction
Abhishek Jain, SN Sankhwar, Apul Goel
Department of Urology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
|Date of Web Publication||12-Jul-2010|
Department of Urology, King George Medical University, Lucknow 226003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain A, Sankhwar S N, Goel A. Bladder wall thickness for the assessment of voiding dysfunction. Indian J Urol 2010;26:319-20
Blatt AH, Titus J, Chan L. Ultrasound measurement of bladder wall thickness in the assessment of voiding dysfunction. J Urol. 2008;179(6):2275-8.
| Summary|| |
In this study, authors have used transabdominal ultrasound to correlate bladder wall thickness (BWT) with bladder outlet obstruction and other non-neurogenic voiding dysfunction, as a useful noninvasive diagnostic parameter for bladder outlet obstruction. One-eighty patients (73 males, 107 females) of non-neurogenic voiding dysfunction were included in this study prospectively. All patients underwent uroflowmetry, medium fill cystometry, pressure flow study, and multichannel video urodynamics. Transabdominal ultrasonography was performed during urodynamics study by a 5.2 MHz convex transducer and a 10.5 MHz linear transducer, at 200 ml bladder volume. Two BWTs were measured 1 cm apart in sagittal plane just above pubic symphysis to measure wall thickness of anterior bladder wall. The measurements were then averaged. For statistical analysis authors used ANOVA and student t test, and P < 0.05 was taken as significant. Mean BWT was 2 mm ± 0.5, 2.1 mm ± 0.4, 1.9 mm ± 0.4, 1.8 mm ± 0.4 in patients with normal urodynamics, BOO, detrusor overactivity, and increased bladder sensations, respectively. Authors reported that there is no statistical difference in BWT between patients with normal urodynamics study and those with BOO. Study found that males had a slightly thicker BWT than female (2.1 mm vs. 1.9 mm), but not statistically significant and no association between age or gender and BWT was present. Authors were unable to conclude a cut-off point to predict BOO.
| Comments|| |
To diagnose voiding dysfunction, urodynamics study is considered gold standard test, but various investigators have tried to evaluate various noninvasive tests to predict voiding dysfunction, for example, International Prostatic Symptoms Score (IPSS), post-void residual (PVR) urine, BWT, and ultrasound estimated bladder weight (UEBW). Various other authors attempted to correlate BWT and voiding dysfunction. Manieri et al.1996 first reported that a BWT of more than 5 mm was the best cut-off point to diagnose BOO, since 63.3% of patients with BWT <5 mm were unobstructed while 87.5% of those with a BWT >5 mm were obstructed. 
Kessler et al. 2006 reported that BWT ≥2.9 mm is the best cut-off point with a 100% positive predictive point and 54% negative predictive point, 100% specificity, and 43% sensitivity.  Recently Oelke et al. 2007 chose a cut-off of 2 mm and 89% accuracy for diagnosing BOO. 
Contrary to above evidence, the authors in this present study did not found any statistically significant difference between obstructed and nonobstructed BWT. Nonsignificant difference of BWT in this study may be due to the patient duration of symptoms that were not studied, heterogeneous patients group, and gender bias.
Thus, to establish BWT as a useful predictor of BOO further studies with a consensus over BWT are required.
| References|| |
|1.||Manieri C, Carter SS, Romano G, Trucchi A, Valenti M, Tubaro A. The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J Urol 1998;159:761. [PUBMED] [FULLTEXT] |
|2.||Kessler TM, Gerber R Burkhard FC, Studer UE, Danuser H. Ultrasound assessment of detrusor thickness in men: Can it predict bladder outlet obstruction and replace pressure flow study? J Urol 2006;175:2170-3. |
|3.||Oelke M, Hofne k, Jonas U, de la Rosette J, Ubbink D, Wijkstra H. Diagnostic accuracy of non invasive tests to evaluate bladder outlet obstruction in men: Detrusor wall thickness, Uroflowmetry, post void residual urine and prostate volume. Eur Urol 2007;52:827-34. |