UJ 35 Summer.pdf 586 | Female Urology Ultrasound Estimated Bladder Weight in Asymptomatic Adult Females Ghadeer Al-Shaikh, Hazem Al-Mandeel Purpose: and interobserver reproducibility of this method. Materials and Methods: from hospital staff and patients attending the gynecological clinic over a period of six months. All Results: - der volume. Conclusion: females yields reproducible measurements and can be used as a reference for future understand- disorders. Keywords: Corresponding Author: Ghadeer Al-Shaikh, MBBS; FRCSC College of Medicine (Box #12), P.O. Box 231214, King Saud University, Riyadh, 11321, Saudi Arabia Tel: +966 146 9339 Fax: +966 1467 9557 E-mail: ghadeer-alshaikh@ hotmail.com Received January 2012 Accepted May 2012 Departments of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia FEMALE UROLOGY 587Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L Ultrasound Estimated Bladder Weight | Al-Shaikh and Al-Mandeel INTRODUCTION Lurinary incontinence or voiding disorders, af- (1) - vestigations to obtain a diagnosis and initiate treatment. - generally invasive, time-consuming, and inconvenient to most patients, and may cause urinary tract infection.(2) (3,4) - (5) - (6) Recently, the BladderScan has been developed. The device uses three-dimensional (3-D) ultrasound as opposed to the 2-D ultrasound origi- device calculates the surface area of the bladder rather than assuming the bladder as a sphere. A study on the validity and reproducibility of the device measurement using manual measurement by 2-D ultrasound and con- - (7) - limits its use in everyday practice. Therefore, calculated - and colleagues found that 3-D ultrasound estimation of (7) An ad- volumes; thereby, avoiding unnecessary catheterization (7) Bright and asso- - - respectively. Several studies have used ultrasonography to assess - (3,5,9,10) the intra-observer and interobserver reproducibility of MATERIALS AND METHODS After institutional ethical approval to conduct the study - tients attending the gynecological clinic in King Khalid - validated instrument commonly used in urogynecology - estimation.(11,12) Exclusion criteria include the presence - ing pregnant, and declining to have the test. An informed - ticipation. - 588 | - WA) at a bladder capacity of 150 to 400 mL as per de- - - to the bladder direction. Thereafter, the bladder region is delineated precisely to calculate the actual surface area s), t p) us- s t p(7) intra-observer and interobserver reproducibility of the - The probe is placed approximately 3 cm superior to the symphysis pubis. The scanner automatically detects mis- alignment of the probe and directs the user to the optimal - - out as appropriate (median, mean, frequency, and per- centages). The reproducibility analysis consisted of in- terobserver agreement and intra-observer consistency - - assumed some reliability; 0.21 to 0.40 fair; 0.41 to 0.60 reliability.(13) RESULTS 2 (Table 1). Of partici- had a previous cesarean section, and none had undergone - P < .001). (P (Table 2; P - - DISCUSSION - - sess the state of bladder hypertrophy secondary to outlet obstruction and detrusor overactivity, as an alternative method to invasive, expensive, and time-consuming uro- Table 1. Association between specific sample characteristics and ultrasonic evaluation of the bladder weight. Characteristics Mean (± standard deviation) Range r P Age, y 37.5 (11.1) 18 to 65 0.02 .26 Height, cm 155.6 (6) 143 to 175 0.05 .36 Weight, kg 66.7 (14.5) 32 to 106 0.09 .06 Body mass index, kg/m2 27.5 (5.6) 13 to 42 0.19 .10 Female Urology 589Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L tests for bladder outlet obstruction, the authors conclud- ed that BWT is a promising measurement that has the potential to replace urodynamic evaluation.(14) as a clinical tool becomes limited in everyday practice. Kojima and colleagues attempted to resolve this problem - - sessing bladder function beside urodynamic parameters. (5,9) healthy asymptomatic population. Such normative data (6) - - viation: 4.9) and mean BWT is 1.62 mm (standard devia- tion: 0.34). The use of a portable automated ultrasound highly to moderately reproducible values both in the in- tra-observer and interobserver measurements. (15) The results of this study can be a base for understanding Table 2. Reliability of BladderScan BVM 9500 for ultrasonic evaluation of the bladder weight and bladder wall thickness measurements. Ultrasound Estimated Bladder Weight Bladder Wall Thickness Mean (SD), g Range Intra-observer correlation coefficient Interobserver correlation coefficient Mean (SD), mm Range Intra-observer correlation coefficient Interobserver correlation coefficient Operator 1 Trial 1 32.05 (4.86) 22 to 45 0.8 0.81 1.61 (0.35) 1 to 3 0.47 0.6 Trial 2 32.20 (4.75) 21 to 43 1.61 (0.31) 1 to 3 Operator 2 Trial 3 32.0 (4.78) 22 to 48 0.79 1.62 (0.37) 1 to 3 0.55 Trial 4 32.66 (4.91) 21 to 43 1.63 (0.33) 1 to 2 SD indicates standard deviation. Ultrasound Estimated Bladder Weight | Al-Shaikh and Al-Mandeel Figure 2. The Bland-Altman plot of the interobserver reproduc- ibility for bladder wall thickness. Figure 1. The Bland-Altman plot of the interobserver reproduc- ibility for ultrasonic evaluation of the bladder weight. D iff er en ce in E BW b y tw o op er at or s (1 st o b se rv at io n ) D iff er en ce in W T b y tw o op er at or s (1 st o b se rv at io n ) - 590 | - - pecially that the measurement techniques for bladder (6) Therefore, automated method for - large residuals secondary to chronic retention. - attention to the predictive diagnostic performance of the CONCLUSION - ble of evaluating bladder hypertrophy in female patients ACKNOWLEDGEMENTS - - tion; Rosalia Mahmoud for helping us in collecting the - ting the manuscript based on publication requirements statistical analysis. CONFLICT OF INTEREST None declared. REFERENCES 1. Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:301-19. 2. Klingler HC, Madersbacher S, Djavan B, Schatzl G, Mar- berger M, Schmidbauer CP. Morbidity of the evaluation of the lower urinary tract with transurethral multichannel pressure-flow studies. J Urol. 1998;159:191-4. 3. Kojima M, Inui E, Ochiai A, Naya Y, Ukimura O, Watanabe H. Noninvasive quantitative estimation of infravesical ob- struction using ultrasonic measurement of bladder weight. J Urol. 1997;157:476-9. 4. Khullar V, Cardozo LD, Salvatore S, Hill S. Ultrasound: a non- invasive screening test for detrusor instability. Br J Obstet Gynaecol. 1996;103:904-8. 5. Kojima M, Inui E, Ochiai A, Naya Y, Ukimura O, Watanabe H. Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology. 1996;47:942-7. 6. Bright E, Oelke M, Tubaro A, Abrams P. Ultrasound esti- mated bladder weight and measurement of bladder wall thickness--useful noninvasive methods for assessing the lower urinary tract? J Urol. 2010;184:1847-54. 7. Chalana V, Dudycha S, Yuk JT, McMorrow G. Automatic Measurement of Ultrasound-Estimated Bladder Weight (UEBW) from Three-Dimensional Ultrasound. Rev Urol. 2005;7 Suppl 6:S22-8. 8. Bright E, Pearcy R, Abrams P. Automatic evaluation of ultrasonography-estimated bladder weight and bladder wall thickness in community-dwelling men with presum- ably normal bladder function. BJU Int. 2012;109:1044-9. 9. Naya Y, Kojima M, Honjyo H, Ochiai A, Ukimura O, Wata- nabe H. Intraobserver and interobserver variance in the measurement of ultrasound-estimated bladder weight. Ultrasound Med Biol. 1998;24:771-3. 10. Kojima M, Inui E, Ochial A, Ukimura O, Watanabe H. Possible use of ultrasonically-estimated bladder weight in patients with neurogenic bladder dysfunction. Neurourol Urodyn. 1996;15:641-9. 11. Ross S, Soroka D, Karahalios A, Glazener CM, Hay-Smith EJ, Drutz HP. Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:272-85. Female Urology 591Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L 12. Altaweel W, Seyam R, Mokhtar A, Kumar P, Hanash K. Arabic validation of the short form of Urogenital Distress Invento- ry (UDI-6) questionnaire. Neurourol Urodyn. 2009;28:330-4. 13. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420-8. 14. Belal M, Abrams P. Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: Nonurodynamic approach. J Urol. 2006;176:22-8. 15. Morris V, Steventon N, Hazbun S, Wagg A. A cross-sectional study of ultrasound estimated bladder weight in a sample of men and women without lower urinary tract symptoms. Neurourol Urodyn. 2009;28:995-7. Ultrasound Estimated Bladder Weight | Al-Shaikh and Al-Mandeel