Abstract
Purpose
To establish a parameter-based grading system for evaluating bladder trabeculation (BT).
Materials and methods
A retrospective analysis was conducted on children diagnosed with posterior urethral valve (PUV) or neurogenic bladder (NB) who underwent voiding cystourethrogram (VCUG), urodynamic testing, and urological ultrasonography between January 2016 and October 2022. Cases involving urologic surgery, secondary bladder pathology, and an interval of more than 12 months between examinations were excluded. A parameter named Bladder Dispersion (BD) was calculated through fluoroscopic images, and the grading system was developed as follows: BD < 40 (Grade 0), 40 ≤ BD < 60 (Grade 1), 60 ≤ BD < 90 (Grade 2), BD ≥ 90 (Grade 3). Grades 0–1 were classified as low-risk group, while grades 2–3 were classified as high-risk group. Analysis of variance, Kruskal–Wallis test, and Chi-square test were performed to compare urodynamic results and complications across different grades and groups.
Results
A total of 74 patients were eligible to participate, which included 46 boys (62.2%) and 28 girls (37.8%), the mean age was 75.18 ± 48.39 months. Among them, 11 (14.9%) were PUV, 50 (67.6%) were NB, and 13 (17.5%) were PUV and NB. Significant differences were observed in maximum detrusor pressure, post-void residual urine ratio, and compliance among grades 0–3. Severe hydronephrosis and histories of urinary tract infection were more prevalent in the high-risk group.
Conclusion
A reliable grading system with objective standards was proposed which could aid in the assessment of BT severity.
Similar content being viewed by others
Data availability
On demand.
Abbreviations
- BT:
-
Bladder trabeculation
- VCUG:
-
Voiding cystourethrogram
- PUV:
-
Posterior urethral valve
- NB:
-
Neurogenic bladder
- LUTS:
-
Lower urinary tract symptoms
- UTI:
-
Urinary tract infection
- VUR:
-
Vesicoureteral reflux
- BD:
-
Bladder dispersion
- MDP:
-
Maximum detrusor pressure
- C:
-
Compliance
- BC:
-
Bladder capacity
- PVR:
-
Post-void residual urine
- PVR-R:
-
Post-void residual urine ratio
References
Bai SW, Park SH, Chung DJ, Park JH, Shin JS, Kim SK, Park KH (2005) The significance of bladder trabeculation in the female lower urinary system: an objective evaluation by urodynamic studies. Yonsei Med J 46(5):673–678. https://doi.org/10.3349/ymj.2005.46.5.673
Cho SY, Bae J, Yoo C, Oh SJ (2013) Establishment of a grading system for bladder trabeculation. Urology 81(3):503–507. https://doi.org/10.1016/j.urology.2012.11.041
Jung JH, Cho SY, Yoo C, Oh SJ (2014) Establishment of the novel cystoscopic classification for bladder trabeculation of neurogenic bladder. Urology 84(3):515–519. https://doi.org/10.1016/j.urology.2014.05.015
Won YH, Kim DS, Kim GW, Park SH, Ko MH, Seo JH (2022) Association of bladder trabeculation and neurogenic bladder with spinal cord injury. J Int Med Res 50(6):665801600. https://doi.org/10.1177/03000605221104768
Lu YT, Tingskov SJ, Djurhuus JC, Norregaard R, Olsen LH (2017) Can bladder fibrosis in congenital urinary tract obstruction be reversed? J Pediatr Urol 13(6):574–580. https://doi.org/10.1016/j.jpurol.2017.08.013
Selby B, Hidas G, Chuang KW, Soltani T, Billimek J, Kaplan S, Wehbi E, Khoury A (2020) Development and validation of a bladder trabeculation grading system in pediatric neurogenic bladder. J Pediatr Urol 16(3):367–370. https://doi.org/10.1016/j.jpurol.2020.03.007
Hirshberg BV, Myers DT, Williams TR (2018) The “Christmas tree” bladder. Abdom Radiol (NY) 43(12):3525–3526. https://doi.org/10.1007/s00261-018-1648-3
Khoury AE, Dave S, Peralta-Del VM, Braga LH, Lorenzo AJ, Bagli D (2008) Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder. Bju Int 101(2):223–226. https://doi.org/10.1111/j.1464-410X.2007.07164.x
Kim SJ, Kim J, Na YG, Kim KH (2021) Irreversible bladder remodeling induced by fibrosis. Int Neurourol J 25(Suppl 1):S3–S7. https://doi.org/10.5213/inj.2142174.087
Kumano Y, Hayashi C, Gohbara A, Yamazaki Y (2020) A simple screening tool for an unfavorable bladder in children with myelomeningocele: Is the height to width ratio of the cystogram useful to predict high-pressure bladder? J Pediatr Urol 16(6):831–839. https://doi.org/10.1016/j.jpurol.2020.09.015
Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P (2015) International Children’s Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn 34(7):640–647. https://doi.org/10.1002/nau.22783
Cicione A, Lombardo R, Nacchia A, Turchi B, Gallo G, Zammitti F, Ghezzo N, Guidotti A, Franco A, Rovesti LM, Gravina C, Mancini E, Riolo S, Pastore A, Tema G, Carter S, Vicentini C, Tubaro A, De Nunzio C (2022) Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram. World J Urol. https://doi.org/10.1007/s00345-022-04259-x
Benfield MR (2003) Current status of kidney transplant: update 2003. Pediatr Clin North Am 50(6):1301–1334. https://doi.org/10.1016/s0031-3955(03)00122-6
Saad IR, Habib E, Elsheemy MS, Abdel-Hakim M, Sheba M, Mosleh A, Salah DM, Bazaraa H, Fadel FI, Morsi HA, Badawy H (2016) Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study. Bju Int 118(2):320–326. https://doi.org/10.1111/bju.13347
Hennus PM, van der Heijden GJ, Bosch JL, de Jong TP, de Kort LM (2012) A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS ONE 7(9):e44663. https://doi.org/10.1371/journal.pone.0044663
Metcalfe PD, Wang J, Jiao H, Huang Y, Hori K, Moore RB, Tredget EE (2010) Bladder outlet obstruction: progression from inflammation to fibrosis. Bju Int 106(11):1686–1694. https://doi.org/10.1111/j.1464-410X.2010.09445.x
Rodriguez RF, Townsend NE, Aughey RJ, Billaut F (2018) Influence of averaging method on muscle deoxygenation interpretation during repeated-sprint exercise. Scand J Med Sci Sports 28(11):2263–2271. https://doi.org/10.1111/sms.13238
Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Neveus T (2016) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn 35(4):471–481. https://doi.org/10.1002/nau.22751
Ghanem MA, Wolffenbuttel KP, De Vylder A, Nijman RJ (2004) Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol 171(6 Pt 1):2409–2412. https://doi.org/10.1097/01.ju.0000127762.95045.93
Jaureguizar E, Lopez-Pereira P, Martinez-Urrutia MJ (2002) The valve bladder: etiology and outcome. Curr Urol Rep 3(2):115–120. https://doi.org/10.1007/s11934-002-0021-8
Taskinen S, Heikkila J, Rintala R (2012) Effects of posterior urethral valves on long-term bladder and sexual function. Nat Rev Urol 9(12):699–706. https://doi.org/10.1038/nrurol.2012.196
Rubilotta E, Balzarro M, Trabacchin N, Righetti R, D’Amico A, Blaivas JG, Antonelli A (2021) Post-void residual urine ratio: a novel clinical approach to the post-void residual urine in the assessment of males with lower urinary tract symptoms. Investig Clin Urol 62(4):470–476. https://doi.org/10.4111/icu.20200560
Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD (2008) Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol 180(1):47–54. https://doi.org/10.1016/j.juro.2008.03.027
Wiener JS, Huck N, Blais AS, Rickard M, Lorenzo A, Di Carlo H, Mueller MG, Stein R (2021) Challenges in pediatric urologic practice: a lifelong view. World J Urol 39(4):981–991. https://doi.org/10.1007/s00345-020-03203-1
Shaikh N, Ewing AL, Bhatnagar S, Hoberman A (2010) Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 126(6):1084–1091. https://doi.org/10.1542/peds.2010-0685
Chen HS, Liu X, Zhang ZC, Ye ZH, Lin T, He DW, Wei GH (2022) Computational fluid dynamics modeling approaches to assess lower urinary tract hydraulic dynamics in posterior urethral valve before and after endoscopic valve ablation: a pilot study. World J Urol 40(2):505–511. https://doi.org/10.1007/s00345-021-03875-3
Acknowledgements
The authors would like to thank Department of Urology Children’s Hospital of Chongqing Medical University for providing data for this work. This research was partially supported by the Program for Youth Innovation in Future Medicine, Chongqing Medical University, Yuzhong, Chongqing, People’s Republic of China.
Funding
This work was supported by the Program for Youth Innovation in Future Medicine, Chongqing Medical University, Yuzhong, Chongqing, People’s Republic of China.
Author information
Authors and Affiliations
Contributions
XW: designed the study, analyzed the images, and drafted the manuscript. XL: designed the study and manuscript editing. HC, CW, XL, YW, ZY: participated in the imaging analysis and manuscript writing. GW: revised the manuscript and helped analyze images. All authors reviewed and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest.
Ethical approval
The study was approved by the Ethics Committee of Children’s Hospital of Chongqing Medical University (Approval number 2023267).
Informed consent
Consent was taken from all participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, X., Chen, Hs., Wang, C. et al. A grading system for evaluation of bladder trabeculation. World J Urol 41, 2443–2449 (2023). https://doi.org/10.1007/s00345-023-04527-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-023-04527-4