Emi Inui

Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: A preliminary report

The aim of the present study was to evaluate the usefulness of ultrasonic estimation of bladder weight as a measure of bladder hypertrophy using transabdominal ultrasonography in men with infravesical obstruction. Ultrasonically estimated bladder weight (UEBW) was calculated from the thickness of the bladder wall measured ultrasonically and the intravesical volume at the ultrasonic measurement, assuming a spheric bladder. There was a statistically significant correlation (r = 0.970, P <0.001) between the actual bladder weight of cadaver bladders and the UEBW. The UEBW did not change with bladder filling. The UEBW in the obstructed group (group O, 49.7 +/- 19.5 g, mean +/- SD) was significantly greater than that in the normal control group (group NC, 25.6 +/- 5.7 g; P <0.001) or the nonobstructed group (group NO, 28.4 +/- 4.2 g; P <0.001). The greatest UEBW was 34.8 g in group NC and 35.2 g in group NO, whereas 94% (45 of 48) of group O had a UEBW greater than 35.0 g. In all 5 patients with benign prostatic hyperplasia (BPH), the increased UEBW decreased to a normal control level at 3 months after treatment of BPH. This new noninvasive method may be useful in investigation of bladder hypertrophy.

Noninvasive Quantitative Estimation of Infravesical Obstruction Using Ultrasonic Measurement of Bladder Weight

PURPOSE Ultrasound estimated bladder weight was compared to pressure-flow studies to test the ability of ultrasound estimated bladder weight to predict infravesical obstruction. MATERIALS AND METHODS A total of 65 men with urinary symptoms underwent ultrasonic measurement of bladder weight and pressure-flow studies. Assuming the bladder is a sphere, ultrasound estimated bladder weight was calculated from bladder wall thickness measured ultrasonically and intravesical volume. RESULTS Ultrasound estimated bladder weight correlated significantly (p < 0.0001) with the Abrams-Griffiths number, urethral resistance factor and the Schäfer grade of obstruction. A cutoff value of 35 gm. for ultrasound estimated bladder weight revealed a diagnostic accuracy of 86.2% (56 of 65 cases) for infravesical obstruction with 12.1 (4 of 33) and 15.6% (5 of 32) false-positive and false-negative rates, respectively. CONCLUSIONS Ultrasound estimated bladder weight can be measured noninvasively at the bedside and it is promising as a reliable predictor of infravesical obstruction.

Reversible Change of Bladder Hypertrophy Due to Benign Prostatic Hyperplasia After Surgical Relief of Obstruction

PURPOSE Ultrasound estimated bladder weight was compared before and after surgery for benign prostatic hyperplasia (BPH) to reveal a possible reversible change in bladder hypertrophy. MATERIALS AND METHODS Ultrasound estimated bladder weight was measured before and after subcapsular (17) or transurethral (16) prostatectomy in 33 male patients with BPH. Sequential changes in the American Urological Association symptom score and urinary flow rate were also examined. RESULTS Along with a significant improvement in the American Urological Association symptom scores and maximum flow rate, ultrasound estimated bladder weight decreased from 52.9 +/- 22.6 to 31.6 +/- 15.8 gm. in 12 weeks after treatment. In all but 4 patients (29 of 33, or 87.9%) ultrasound estimated bladder weight decreased to less than 35.0 gm. in 12 weeks after treatment. Interestingly, in all patients with an initial ultrasound estimated bladder weight of greater than 80 gm. the bladder weight still remained at an abnormally high level 12 weeks after treatment. CONCLUSIONS Bladder hypertrophy was completely reversible after the surgical treatment of the obstruction in the majority of patients with BPH. The measurement of ultrasound estimated bladder weight was of value in monitoring therapeutic effects in BPH patients. An extraordinarily high ultrasound estimated bladder weight of 80 gm. or more might suggest degenerative and irreversible pathological changes in the bladder detrusor.

Comparative morphometric study of bladder detrusor between patients with benign prostatic hyperplasia and controls

PURPOSE We determined the change in the amount of connective tissue of the detrusor in patients with benign prostatic hyperplasia (BPH) in relation to the degree of bladder hypertrophy by ultrasound estimated bladder weight. The ratio of connective tissue-to-smooth muscle between controls and BPH cases was compared. MATERIALS AND METHODS For normal controls we used cadaver bladders excised at autopsy from 13 men with no urinary tract diseases. Bladder wall samples were also obtained at subcapsular prostatectomy for BPH in 26 patients. On thin sections stained with Masson trichrome, the ratio of connective tissue-to-smooth muscle was measured using a computer assisted color image analysis. This ratio was compared in BPH cases with estimated bladder weight, which was measured preoperatively using transabdominal ultrasonography. RESULTS A connective tissue-to-smooth muscle ratio ranged from 19.8 to 28.2% (mean plus or minus standard deviation 24.7+/-2.4) and from 12.9 to 53.3% (27.3+/-9.9) in control and BPH cases, respectively. In BPH cases a significant correlation was noted between estimated bladder weight and connective tissue-to-smooth muscle ratio (r=0.788, p <0.0001). Interestingly, in BPH cases with an estimated bladder weight of less than 60 gm. the ratio ranged from 12.9 to 30.4% (22.8+/-4.9), which was not significantly different compared to control cases. In contrast, in all BPH cases with an estimated bladder weight of 60 gm. or more connective tissue-to-smooth muscle ratio increased significantly to more than 30% (range 33.4 to 53.3%, mean 42.2+/-13.6%). CONCLUSIONS These results suggest that abnormal increase of connective tissue in addition to smooth muscle hypertrophy and/or hyperplasia could contribute to advanced bladder hypertrophy caused by infravesical obstruction.

A STATISTICAL STUDY OF THE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX FOR BENIGN PROSTATIC HYPERPLASIA IN PARTICIPANTS OF MASS SCREENING PROGRAM FOR PROSTATIC DISEASES USING TRANSRECTAL SONOGRAPHY

PURPOSE A study was done on the prevalence of urinary symptoms in community based populations in Japan regarding the influences of aging and benign prostatic hyperplasia (BPH) as evaluated by transrectal sonography. MATERIALS AND METHODS In 961 Japanese men 55 to 87 years old who underwent mass screening for prostatic diseases the American Urological Association symptom index scores were compared with age and ultrasonic diagnosis of the prostate. RESULTS Moderate to severe symptoms (symptom score 8 or more) were found in 265 of our 961 samples (27.6%), while BPH was also recognized ultrasonically in 197 (20.5%). Frequencies of urinary symptoms and BPH increased significantly with age. BPH related increase in total symptom scores occurred only in select men when adjusted by age. CONCLUSIONS The ability of the American Urological Association symptom index to characterize BPH in an individual was limited because of the lack of specificity to the disease along with the considerable influence of aging on the symptom score. Currently, transrectal sonography is the most reliable method for the definitive diagnosis of BPH.

NONINVASIVE EVALUATION OF BLADDER COMPLIANCE IN CHILDREN USING ULTRASOUND ESTIMATED BLADDER WEIGHT

PURPOSE In healthy children as well as those with urinary disturbance we determined ultrasound estimated bladder weight with the aim of revealing its possible usefulness as a measure of bladder compliance. MATERIALS AND METHODS We measured ultrasound estimated bladder weight in 71 healthy children with a mean age of 10.3 years, and determined a standard value. A total of 82 patients with a mean age of 9.6 years with urinary disturbance also underwent ultrasound estimated bladder weight measurement as well as conventional urological examinations, including filling cystometry. RESULTS In healthy children ultrasound estimated bladder weight increased with age, showing a significant linear correlation (r = 0.80, p < 0.0001). Using the formula for linear correlation, 0.86 x patient age + 6.9 gm., we obtained an age matched estimated weight. In 82 patients the percent deviation of the estimate from age matched values was calculated using the formula, (measured ultrasound estimated bladder weight -age matched ultrasound estimated bladder weight)/age matched ultrasound estimated bladder weight x 100, and then correlated with bladder compliance. In 75 of 77 patients (97%) with compliance of 10 ml./cm. water or more the estimate was within 100% deviation. In contrast, 4 of 5 patients (80%) with a low compliant bladder (less than 10 ml./cm. water) had an ultrasound estimated bladder weight greater than 100% deviation. When the estimate was within 100% deviation, all but 1 patient (75 of 76, 98.7%) had compliance of 10 ml./cm. water or more compared to 33.3% (2 of 6) of those with an estimate greater than 100% deviation. As a result, with the use of a cutoff value of 100% deviation ultrasound estimated bladder weight predicted a low compliant bladder with a diagnostic accuracy as high as 96.3% (79 of 82 cases). CONCLUSIONS Ultrasound estimated bladder weight may be used to evaluate bladder compliance in children. It seems to be a suitable noninvasive urodynamic test in children with suspected urodynamic abnormalities.

Combined Adrenal Myelolipoma and Pheochromocytoma

A 39-year-old woman had a 2-year history of headache and hyperhidrosis. Magnetic resonance imaging showed 2 right adrenal tumors with different intensities (fig. 1). 131Metaiodobenzylguanidine scintigraphy revealed accumulation at the ventral tumor. Serum levels of norepinephrine were increased (579 pg.1 ml., normal 94 to 322). A %-hour urine sample revealed abnormally increased levels of dopamine (9,206 pg., normal 190 to 7401, norepinephrine (250 pg., normal 26 to 1211, epinephrine (312 pg., normal 3 to 15), normetanephrine (2.25 mglml., normal 0.04 to 0.18) and vanillylmandelic acid (11.2 mglml., normal 0.7 to 7.0). Adrenocorticotropic hormone, cortisol and aldosterone were normal (less than 60 pg./ml., 5.6 to 21.3 pg ld l . and 2 to 3 ng./dl., respectively). Based on these results right adrenal myelolipoma combined with pheochmmocytorna was suspected and surgical extirpation was performed. Pathological evaluation revealed that the ventral tumor was a 47 X 45 X 40 mm. 48 gm. pheochmmocytoma and the dorsal tumor was a 43 X 34 X 30 mm. 23 gm. myelolipoma (fig. 2). Quantitative analysis of

POSSIBLE USE OF ULTRASONICALLY-ESTIMATED BLADDER WEIGHT IN PATIENTS WITH NEUROGENIC BLADDER DYSFUNCTION

In 25 patients with detrusor areflexia, ultrasonically‐estimated bladder weight (UEBW) was compared with bladder capacity and compliance obtained by cystometry, and UEBW was also compared with grade of bladder deformity as evaluated by cystography. UEBW correlated significantly with compliance (P < 0.01) and degree of bladder deformity (P < 0.01). Taking a cutoff value of 40 g, UEBW revealed diagnostic accuracy as high as 96% and 80% for low‐compliance (< 10 ml/cm H2O) and high‐grade deformity (grade II/III), respectively. UEBW could be a new urodynamic parameter capable of evaluating functional as well as morphological changes of the bladder.