Urodynamic 4D-CT evaluation: 320-row area detector CT scanner combined with PhyZiodynamics software analysis provides an innovative system to evaluate urinary flow and outlet obstructions

2019 ◽  
Vol 61 (4) ◽  
pp. 558-567
Author(s):  
Shintaro Mori ◽  
Hideki Yashiro ◽  
Masanori Inoue ◽  
Kiyoshi Takahara ◽  
Mamoru Kusaka ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Urinary Flow ◽  
Ct Scanner ◽  
4D Ct ◽  
Software Analysis ◽  
Area Detector ◽  
Lower Urinary Tract Obstruction ◽  
Lower Urinary

Background Evaluation of the morphology of the lower urinary tract as well as the movements associated with urination are required for the symptomatic diagnosis of lower urinary tract obstruction as well as the assessment of postoperative adaptation. However, no tool currently exists for direct and easy patient evaluation. Purpose To evaluate lower urinary tract obstruction and postoperative adaptation using a four-dimensional (4D) virtual reality urination image (urodynamic 4D-CT image). Material and Methods We used a 320-row area detector CT scanner and PhyZiodynamics image analysis software to perform 197 urodynamic 4D-CT examinations on 175 first-time patients between January 2014 and March 2017. Results A comparison of the obtained images before and after holmium laser enucleation of the prostate revealed the morphological changes due to prostate enucleation and enabled visualization of the ideal urination conditions, showing that the anatomical structural changes during urination and the opening of the urethra play a major role in improving voiding function. Conclusion Using low-dosage radiation, the sharply defined moving image obtained via urodynamic 4D-CT examination can be utilized as a physiological diagnostic tool to evaluate a series of urinary movements from any angle between the prostate, urethra, and bladder in a unitary manner with the time axis added. There was negligible patient impact. This technique could provide new opportunities for the diagnosis of lower urinary tract symptoms and post-surgical adaptation assessment.

Myokardiale Funktion bei Feten mit Lower Urinary Tract Obstruction

2018 ◽  
Author(s):  
O Graupner ◽  
C Enzensberger ◽  
M Götte ◽  
A Wolter ◽  
V Müller ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Lower Urinary Tract Obstruction ◽  
Lower Urinary

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

2021 ◽  
pp. 1-13
Author(s):  
R. Douglas Wilson ◽  
Gregg Nelson
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Fetal Surgery ◽  
Fetal Therapy ◽  
Lower Urinary Tract Obstruction ◽  
Evidenced Based ◽  
Process Elements ◽  
Lower Urinary

<b><i>Background:</i></b> Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. <b><i>Problem:</i></b> The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. <b><i>Methods:</i></b> A quality improvement review Squire 2.0 (2000–2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. <b><i>Interventions:</i></b> Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. <b><i>Results:</i></b> A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. <b><i>Conclusions:</i></b> The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.

PERCUTANEOUS BLADDER ASPIRATION AND OTHER METHODS OF URINE COLLECTION FOR BACTERIOLOGIC STUDY

PEDIATRICS ◽  
1965 ◽  
Vol 36 (1) ◽  
pp. 128-131
Author(s):  
Charles V. Pryles
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Needle Aspiration ◽  
Percutaneous Aspiration ◽  
Term Neonates ◽  
The Past ◽  
Lower Urinary Tract Obstruction ◽  
Bladder Urine ◽  
Lower Urinary

IN THE PAST FEW YEARS, a great deal of interest has been focused on the problem of distinguishing true bacteriuria from contamination. The normal urethra is known to harbor bacteria which may contaminate specimens obtained either by voiding or by catheterization. The latter method of obtaining samples may well be the means of introducing organisms that might not have been present before or of replacing sensitive with resistant organisms. Moreover the risk of producing such an infection is greater with the incompletely emptying bladder of lower urinary tract obstruction It has been suggested that percutaneous needle aspiration of the bladder urine may not only be safer than catheterization in some circumstances, but would also obviate contamination of samples during voiding or catheterization. Elsewhere in this issue, Nelson and Peters relate their experience with suprapubic percutaneous aspiration of the urinary bladder in premature and full-term neonates. Aspiration of bladder urine for bacteriologic purposes was first reported in 1956 by Guze and Beeson, who compared colony counts in urine samples obtained both by bladder aspiration and catheter in a small group of women free from urinary tract infection. The following year a comparison of bacterial counts of the urine obtained by needle aspiration of the bladder, catheterization, and midstream collection was described by Manzon and her associates. In 1959 we obtained samples of urine by percutaneous needle aspiration of the bladder and compared the quantitative cultures with those obtained immediately thereafter by catheterization; all these samples were from infants and children prior to elective laparotomies.

scholarly journals Genome-Wide Survey for Microdeletions or -Duplications in 155 Patients with Lower Urinary Tract Obstructions (LUTO)

Genes ◽  
2021 ◽  
Vol 12 (9) ◽  
pp. 1449
Author(s):  
Luca M. Schierbaum ◽  
Sophia Schneider ◽  
Stefan Herms ◽  
Sugirthan Sivalingam ◽  
Julia Fabian ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
De Novo ◽  
Urinary Tract Obstruction ◽  
Posterior Urethral Valves ◽  
Rare Cnvs ◽  
Genome Wide ◽  
Lower Urinary Tract Obstruction ◽  
Human Specific ◽  
Lower Urinary

Lower urinary tract obstruction (LUTO) is, in most cases, caused by anatomical blockage of the bladder outlet. The most common form are posterior urethral valves (PUVs), a male-limited phenotype. Here, we surveyed the genome of 155 LUTO patients to identify disease-causing CNVs. Raw intensity data were collected for CNVs detected in LUTO patients and 4.392 healthy controls using CNVPartition, QuantiSNP and PennCNV. Overlapping CNVs between patients and controls were discarded. Additional filtering implicated CNV frequency in the database of genomic variants, gene content and final visual inspection detecting 37 ultra-rare CNVs. After, prioritization qPCR analysis confirmed 3 microduplications, all detected in PUV patients. One microduplication (5q23.2) occurred de novo in the two remaining microduplications found on chromosome 1p36.21 and 10q23.31. Parental DNA was not available for segregation analysis. All three duplications comprised 11 coding genes: four human specific lncRNA and one microRNA. Three coding genes (FBLIM1, SLC16A12, SNCAIP) and the microRNA MIR107 have previously been shown to be expressed in the developing urinary tract of mouse embryos. We propose that duplications, rare or de novo, contribute to PUV formation, a male-limited phenotype.

scholarly journals Lower Urinary Tract Obstruction

2007 ◽  
Vol 1 (1) ◽  
pp. 40-47
Author(s):  
Julia Hajdu ◽  
Ágnes Harmath ◽  
Barbara Pete ◽  
Papp Zoltan
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Pulmonary Insufficiency ◽  
Lower Urinary Tract Obstruction ◽  
Significant Difference ◽  
Urinary Parameters ◽  
Prenatal Intervention ◽  
Perinatal Survival ◽  
Lower Urinary

Abstract Lower urinary tract obstruction is defined as partial or complete obstruction of the urinary tract at the level of the urethra and the bladder. The posterior urethral valves are the most common cause, 9 percent of the fetal uropathies. The incidence range is wide, because of different databases show different populations. The most severe obstructive uropathy is in patients with kidney damage, oligohydramnios and pulmonary insufficiency. If no prenatal intervention is performed, 45 percent of these patients die in the first 3 weeks of life and 25 percent have renal failure. In utero therapy is indicated to prevent renal damage and pulmonary hypoplasia in cases associated with progressive development of oligohydramnios. The treatment is usually limited to male fetuses with bladder outlet obstruction. The selection criteria (contraindications of fetal intervention) are: normal amniotic fluid volume, suggestion of nonobstructive dilatation of the urinary tract, sonographic evidence of renal cystic dysplasia, abnormal fetal urinary parameters, abnormal karyotype, presence of associated major congenital anomalies, fetal urinary parameters are above threshold. At the follow up after a prenatal intervention showed an apparent statistically significant improvement in perinatal survival with prenatal intervention relative to no intervention. Furthermore, there was no significant difference between the proportions of survivors with normal renal function who underwent bladder drainage and those who did not. Improved perinatal survival was also suggested in those fetuses with a poor prognosis. A nonsignificant improvement in perinatal survival for those fetuses with a good prognosis was also seen.

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