P. Tekkis

Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome.

To assess the relationship between mean bladder wall thickness and components of the overactive bladder (OAB syndrome).

Ultrasound measurement of vaginal wall thickness: a novel and reliable technique

Introduction and hypothesisThe aim of this study was to validate a technique to measure the vaginal wall thickness (VWT) using two-dimensional ultrasound.MethodsWomen were scanned by two independent operators and by the same operator at two separate visits at the level of the bladder neck, the apex of the bladder, the anterior fornix, the anorectal junction, rectum and posterior fornix. Fresh female cadavers were scanned and ultrasound thickness of the vagina was compared to histological thickness.ResultsBland Altman analysis revealed a low mean difference between operators and between visits by the same operator. The 95% confidence intervals as a percentage of the mean vaginal wall thickness ranged between 2.8% and 7.4%. There was a low percentage difference between ultrasound and histological vaginal wall thickness.ConclusionUltrasound vaginal wall thickness demonstrated good intra- and interoperator reliability, as well as consistency with histological measurement. It is a valid technique.

Transvaginal ultrasound measurement of bladder wall thickness: a more reliable approach than transperineal and transabdominal approaches

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b

OC30.08: Bladder wall thickness to assess if anticholinergics work via the sensory or motor route

The aim of this study was to assess the thickness of vaginal tissue in the anterior and posterior vaginal wall in women with vaginal prolapse at three anatomical sites. Methods: We recruited 243 women who had symptomatic pelvic organ prolapse and POP-Q scores of >−2. Transvaginal ultrasound measurement of the full thickness of tissue between the vaginal lumen and the prolapsed pelvic organ was determined by taking measurements at the bladder neck, at the dome of the bladder, and at the anterior fornix, and on the posterior vaginal wall at the anorectal junction, rectum and posterior fornix. POP-Q score allowed grading of the prolapse into 1 (POP-Q −2 to −1), grade 2 (POP-Q between −1 and 0) and grade 3 (POP-Q score > 0). The grade of prolapse was compared to the POP-Q scores. Results: Women with an anterior and posterior compartment prolapse had similar mean vaginal wall thickness measurements at all three anatomical sites on their respective vaginal wall with all 3 grades of prolapse. Pelvic organ prolapse contained within the vagina is associated with a thinner vaginal wall proportional to severity, however once the prolapse has descended below the introitus there is an increase in vaginal wall thickness in both posterior and anterior compartments. Conclusions: Whilst vaginal wall thickness is associated with prolapse severity when the prolapse extends beyond the vaginal introitus, it seems to be uniform in both the anterior and posterior vaginal walls with no difference found at different anatomical sites. This uniform effect rather than in a localised point does not support the fascial defect theory of vaginal prolapse.

OC30.07: The fascial defect theory for vaginal prolapse is not supported by ultrasound measurement of vaginal wall thickness

to age, BMI, parity, time from delivery, episiotomy, epidural anesthesia, birth weight, or delivery mode, but there was a trend towards higher TUI scores with a prolonged second stage (0.061). Women with a higher BMI had larger levator hiatal area dimensions (P=0.05), whereas shorter women tended to have more severe avulsion defects on TUI (P=0.027). Women with an avulsion defect in addition to the perineal tear were also more likely to have anorectal symptoms, although this was statistically significant only for fecal urgency (< 0.05). We observed a decrease in the incidence (61.4% vs. 29.5%, P<0.001) and TUI score of avulsion defects (6.18 ± 6.4 vs. 2.43 ± 4.8, (P<0.001), for the enrolment and last visits, respectively. Conclusion: There seems to be a change in the appearance of levator ani trauma during long term follow-up in women with 3rd and 4th degree perineal tears suggesting the need for continued evaluation.

OC30.01: Vaginal wall thickness is related to the degree of vaginal prolapse

acquisition. Aim of this study was to compare the performance of the AN24 with Doppler FHR monitoring in high risk patients requiring prolonged testing. Study design: Prospective observational study of singletons admitted for fetal monitoring. Each AN24 session was matched 2 : 1 for gestational age (GA), body mass index (BMI), and time of day with a control recording using external Doppler. Percentage of FHR capture was compared for both methods. Results: 93 monitoring sessions (31 cases, 62 controls) were analyzed after verifying proper matching by ANOVA. GA median was 29.0wks [23.1–39.5], median BMI 26.6 [20.1–42.2] and mean monitoring duration 751 minutes [73-1410]. Rate of good capture recordings (> 60%) was similar p>0.05. Overall percentage capture of the FHR was better with Doppler (88% vs 58%, Mann Whitney < 0.001). This difference was primarily due to sessions with low AN24 capture between 26–33.6wks (** =p<0.001, table). Outside this gestational age window both devices perform similar. Conclusion: Monica AN24 fetal ECG monitoring is equivalent Doppler technology early and late in gestation. For extended monitoring between 26–34 weeks, the AN24 technology requires improvement to overcome FHR capture limitations that are most likely due to increased vernix caseosa formation.

OP13.02: Are overactive bladder symptoms better objectively measured using mean bladder wall thickness?

Objectives: Overactive bladder (OAB) symptoms and objective assessment of a these symptoms is complex. A mean bladder wall thickness (BWT) of greater than 5mm is associated with detrusor overactivity but its application as a screening tool is not proved. There are no studies assess urinary symptoms and BWT. The aim of this study was to assess BWT and patient’s symptoms. Methods: One hundred and eighty two women participated. Women completed a HRQoL questionnaire and completed a 4 day bladder diary, and a visual analogue scale for urgency. Women were scanned transvaginally for bladder wall thickness with an empty bladder ( once per night had a mean BWT of 5.3mm (95% CI 5.0–5.5) whereas women with night time frequency of one or less had a mean BWT of 4.3mm (95% CI 4.0–4.7). Women with a VAS urgency score of less than or equal to 2 had a mean BWT of 4.2mm (SD:0.5). Women with a VAS urgency score of > 2 had a mean BWT of 5.2mm (SD 0.77) (p <0.05, Mann Whitney U test). Conclusions: Mean BWT shows a strong association with womens’ OAB symptoms with 85% of the women in our study with OAB having an elevated mean BWT. Elevated mean BWT was associated with increased severity of urgency by VAS, and increased night time frequency. There was no association of mean BWT and daytime frequency. Mean BWT is closely related to both symptoms and diary data. It may be a useful tool in symptom assessment and an objective measure of bladder dysfunction.

OP13.04: Is ultrasound estimation of bladder weight a useful diagnostic tool?

Objectives: Overactive bladder (OAB) symptoms and objective assessment of a these symptoms is complex. A mean bladder wall thickness (BWT) of greater than 5mm is associated with detrusor overactivity but its application as a screening tool is not proved. There are no studies assess urinary symptoms and BWT. The aim of this study was to assess BWT and patient’s symptoms. Methods: One hundred and eighty two women participated. Women completed a HRQoL questionnaire and completed a 4 day bladder diary, and a visual analogue scale for urgency. Women were scanned transvaginally for bladder wall thickness with an empty bladder ( once per night had a mean BWT of 5.3mm (95% CI 5.0–5.5) whereas women with night time frequency of one or less had a mean BWT of 4.3mm (95% CI 4.0–4.7). Women with a VAS urgency score of less than or equal to 2 had a mean BWT of 4.2mm (SD:0.5). Women with a VAS urgency score of > 2 had a mean BWT of 5.2mm (SD 0.77) (p <0.05, Mann Whitney U test). Conclusions: Mean BWT shows a strong association with womens’ OAB symptoms with 85% of the women in our study with OAB having an elevated mean BWT. Elevated mean BWT was associated with increased severity of urgency by VAS, and increased night time frequency. There was no association of mean BWT and daytime frequency. Mean BWT is closely related to both symptoms and diary data. It may be a useful tool in symptom assessment and an objective measure of bladder dysfunction.

OP13.05: Ultrasound measurement of vaginal wall thickness is a novel and reliable technique

Objective: To assess whether ultrasound measurement of vaginal wall thickness demonstrates intra-observer and inter-observer reliability. Method: Twenty five women had a transvaginal ultrasound scan and measurement of the thickness of tissue between the ultrasound probe and the pelvic organ in relation to the vaginal compartment being assessed. On the anterior vaginal wall this was the bladder and on the posterior vaginal wall, the rectum. This distance was termed vaginal wall thickness (VWT) and represented the thickness of the vaginal wall as well as any fascia between the vaginal wall and the pelvic organ. Measurements were taken at three anatomical sites: the bladder neck, dome of the bladder and the anterior fornix on the anterior wall, and the anorectal junction, rectum and posterior fornix on the posterior wall. The scan was repeated by an independent second operator at the first visit. Women then returned 4 to 6 weeks later and the ultrasound measurements of VWT were repeated. The interobserver and intraobserver measurements were analysed at each of the anatomical sites. Results: The mean difference in measurements between the two observers for the bladder neck measurement was 0.3 (SD: 0.41), bladder dome 0.07 (SD: 0.5) and anterior fornix was 0.3 (SD: 0.3). The mean difference at the anorectal junction was −0.02 (SD: 0.4), rectum −0.02 (SD: 0.4) and posterior fornix 0.2 (SD: 0.2). When comparing interoperator difference between visits 1 and 2. Mean difference for the bladder neck measurement was −0.1 (SD: 0.4), bladder −0.1 (SD: 0.3) and anterior fornix 0.07 (SD: 0.3). The anorectal junction was −1.0 (SD: 0.3), rectum −0.14 (SD: 0.4) and posterior fornix −0.05 (SD: 0.4). Conclusions: VWT showed small differences between operators and between the same operators at different visits. It is therefore a reliable technique.