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Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men

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Abstract

Purpose

Detrusor underactivity (DU) has lately gained increasing interest because this bladder condition is an important cause of post-void residual urine and lower urinary tract symptoms (LUTS) in adult men. Until now, DU can only be diagnosed by pressure–flow measurement. Therefore, the aim of this study was to search for noninvasive tests which can safely predict DU in adult men.

Methods

Unselected, treatment-naïve male patients aged ≥40 years with uncomplicated, non-neurogenic LUTS were prospectively evaluated. All men received—after standard assessment of male LUTS–ultrasound detrusor wall thickness (DWT) measurements at a bladder filling ≥250 ml and computer urodynamic investigation. DU was defined as incomplete bladder emptying (>30 ml) in the absence of bladder outlet obstruction or dysfunctional voiding. Classification and regression tree (CART) analysis was used to determine parameters and threshold values for DU.

Results

The study population consisted of 143 consecutive men with medians of 62 years, IPSS 16, and prostate volume 35 ml. In total, 33 patients (23.1 %) had DU. CART analysis showed that all men with DWT ≤ 1.23 mm plus bladder capacity >445 ml had DU. This multivariate model has a sensitivity of 42 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 85 %.

Conclusions

This study showed that all men with ultrasound DWT ≤ 1.23 mm + bladder capacity >445 ml have DU. Combination of these two tests could help physicians to diagnose DU noninvasively in clinical practice. A prospective independent study should confirm these results.

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Author contributions

K.L.J. Rademakers and G.A. van Koeveringe were involved in data collection and management, data analysis, and manuscript writing and editing; M. Oelke was involved in protocol, project development, data collection and management, data analysis, and manuscript writing and editing.

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Authors and Affiliations

  1. Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Kevin L. J. Rademakers & Gommert A. van Koeveringe

  2. Department of Urology, OE 6240, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Matthias Oelke

Authors
  1. Kevin L. J. Rademakers
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  2. Gommert A. van Koeveringe
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  3. Matthias Oelke
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Consortia

on behalf of the FORCE Research Group, Maastricht and Hannover

Corresponding author

Correspondence to Matthias Oelke.

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Conflict of interest

M. Oelke and G. A. van Koeveringe are consultants, speakers and trial participants of Astellas and have been rewarded with the Astellas European Foundation Grant 2012. K.L.J. Rademakers is employed from Astellas European Foundation Grant money.

Ethical standard

The study was carried out with the ethical standards laid down by the 1964 Declaration of Helsinki and later amendments and followed the ethical standard of the local study university. All participants provided informed consent prior to inclusion in the study. All tests performed in the study were part of the routine assessment of the patients.

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Rademakers, K.L.J., van Koeveringe, G.A., Oelke, M. et al. Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men. World J Urol 35, 153–159 (2017). https://doi.org/10.1007/s00345-016-1902-7

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  • DOI: https://doi.org/10.1007/s00345-016-1902-7

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