Summary
Background
Patients with neurogenic bladders are monitored with renal bladder ultrasounds and
video urodynamics studies (VUDS) to assess upper urinary tract injury. Ultrasound
shear wave elastography (US-SWE) can assess tissue stiffness. If bladder compliance
is affected by bladder wall fibrosis and stiffening, then high-pressure bladders may
be detectable by US-SWE therefore reducing the need for VUDS in some patients.
Objective
To determine if US-SWE can differentiate between low- and high-pressure bladders and
hence be used for noninvasive assessment of neurogenic bladder in children.
Study design
Prospective study of patients with neurogenic bladder undergoing clinically indicated
VUDS between February and July of 2017. During VUDS, bladder wall US-SWE was measured
at different filling percentages of estimated bladder capacity (EBC). The bladders
were divided into cohorts according to the detrusor muscle pressure (Pdet) reached at the maximum bladder capacity: normal (1 to <15 cmH2O) and abnormal (≥15 cmH2O) pressure. T-test was used to compare elastography values at different bladder volumes
and Pdet; (statistical significance set at p < 0.05).
Results
30/31 enrolled children completed the protocol. With an empty bladder, as well as
at all other bladder volumes, no relationship was observed between Pdet and mean SWE of the anterior or posterior bladder wall. At maximum bladder capacity,
there was no difference between mean SWE values of the anterior or posterior bladder
walls in those with normal pressure, 2.97 m/s (SD ± 0.82) and 1.96 m/s (SD ± 0.75),
compared to those with abnormal pressures 3.08 m/s (SD ± 0.84) and 2.39 m/s (SD ± 0.96),
p = 0.75 and p = 0.2, respectively.
Discussion
We found no difference between SWE values of either the anterior or posterior bladder
wall in neurogenic bladders with normal and abnormal filling pressures measured during
VUDS. Our study differs from previously reported studies with more positive results
in that our cut-off for abnormal bladder pressure was (Pdet ≥15 cmH2O). This is lower than the more commonly used leak point pressure of 40 cmH2O because our practice is to intervene earlier. Moreover, SWE would be most useful
if it can identify changes before the bladder has reached such severe conditions,
to allow for early intervention. Additional differences between ours and other studies
include US manufacturer and younger age of the participating children.
Conclusions
Summary TableEquipment, patient selection and cut-off values used in studies of pediatric bladder
wall elastography compared with video urodynamic studies. EBC = estimated bladder
capacity; SWE = shear wave elastography; mo = months; y = years; Pdet = detrusor pressure.
| First author [Reference] | n | Age | Pdet threshold for normal | US manufacturer | EBC at SWE assessment | Bladder wall assessed |
|---|---|---|---|---|---|---|
| Calle-Toro | 30 | Median 29 mo Range:1–14 y | 15 cmH2O | Siemens | 0, 25, 50, 75, 100% | Anterior Posterior |
| Shepard [
[18]
],
Smith [ [27]
],
|
25 | Mean 4.2 y Range 1–15 y | Not stated | Siemens | Near empty | Anterior, Right, Left |
| Sturm [
[17]
] |
23 | Median 12 y Range 5–23 y | 25 cmH2O | General Electric | 0, 25, 50, 75, 100%; and end fill | Anterior Posterior |
a abstracts from same authorship group, numbers from larger series presented here.
Keywords
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Article info
Publication history
Published online: March 23, 2022
Accepted:
March 10,
2022
Received in revised form:
March 9,
2022
Received:
August 19,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
