On the issue of birth injuries of the urinary tract of a woman

With minor exceptions, urinary incontinence after childbirth has a traumatic origin. It can be the result of two different reasons, namely, the result of a long standing of the fetal head in the cavity or, more often, in the entrance of the small pelvis and the associated prolonged pressing of the underlying tissues, of which the anterior wall of the vagina with the posterior wall of the bladder and the urethra suffers or re as a result of surgical interventions undertaken for the purpose of delivery without the necessary conditions, more often with an empty bladder and with an unprepared birth canal.

Impact of CT-based planning and bladder volume changes on the dosimetry of vaginal vault brachytherapy

Aim: To compare dose to target and organs at risk (OARs) in conventional plan (2D) versus computed tomography (CT)-based three-dimensional (3D) plan in vaginal cuff brachytherapy (VBT) and to compare the effect of bladder distension on target and OARs dosimetry. Materials and methods: Post-hysterectomy patients with an indication for VBT were included in the study. All patients underwent planning CT scans with a full bladder and an empty bladder protocol. For each CT, two plans were generated—one library-based 2D plan and another CT-based 3D plan. Dosimetric parameters were recorded for clinical target volume (CTV) and OARs. Results: A total of 92 observations were made from data collected from 46 patients. Difference between CTV dose in terms of 2D and 3D plans were not statistically significant for CTV (p = 0·11). Significant reduction in D0·1cc, D1cc and D2cc dose parameters were observed in bladder, rectum, sigmoid and bowel doses with the 3D plan (p < 0·001). Bladder distension showed a 20% reduction in dose for bowel (p < 0·001). Bladder distension also showed a 6·12% (p = 0·047) increase in D2cc, but there was a significant reduction in the mean dose to the bladder. Conclusion: Our study demonstrates the dosimetric benefits with 3D CT-based planning for VBT over 2D-based conventional planning and benefit of bladder distension in the reduction of bowel dose without compromising dose to the target volume.

The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation

Objective: To examine the impact of an empty bladder filling protocol on patients receiving radical RT for localised prostate cancer on post RT toxicity and biochemical progression free survival (bPFS). Methods and materials: Records of patients receiving radical external beam RT (EBRT) for localised prostate cancer with a full or empty bladder were reviewed. These included the bladder size on planning CT, daily online image guided RT (IGRT) setup data, treatment time and post treatment follow up data.These included bPFS, gastrointestinal(GI) and genitourinary(GU) toxicity scoring post RT using the CTCAE v4.0 scoring system. All patients included in the study were planned and treated under the same departmental clinical protocol with VMAT and daily online IGRT corrections. Results: 90 patients were treated with 60 Gy in 20 fractions with a median follow up of 48 months. At 4 years bPFS in the empty bladder group was 100 and 98% in the full bladder group (p = 0.27). There were no statistically significant differences in cumulative ≥Grade 2GU (p = 0.10) and GI (p = 0.27) toxicity rates between the two bladder filling protocols. No statistically significant differences in the IGRT setup between the two groups of patients. Although the median treatment times per fraction were not statistically different between the two groups (p = 0.47), patients in the full bladder filling group were required to spend a longer time in the RT department per treatment session for bladder filling. Conclusion: An empty bladder filling protocol has non-inferior bPFS, GI and GU toxicities at 4 years in patients with localised prostate cancer using advanced RT techniques in comparison to a full bladder filling protocol. A longer follow up with a larger sample size is required to validate this approach. Advances in knowledge: This study suggests that an empty bladder filling protocol can be used in external beam EBRT for localised prostate cancer with non-inferior treatment outcomes.

Müllerian Cyst of the Vagina Masquerading as a Cystocele

Müllerian cysts are usually small, ranging from 0.1 to 2 cm in diameter. Rarely, they may be enlarged and mistaken for other structures, such as a cystocele or urethral diverticulum. We report on a female with symptomatic vaginal wall prolapse, diagnosed as a vaginal Müllerian cyst, which was originally misdiagnosed as a cystocele. The mass was soft and could be compressed manually without difficulty. Perineal ultrasonography and cystoscopy revealed no relationship between the cyst and the lower urinary tract, suggesting independence of the lesion. We performed surgical treatment with complete excision of the mass via a vaginal approach under spinal anaesthesia. The pathology result confirmed a benign Müllerian cyst lined with mucinous and squamous epithelium. When evaluating an anterior vaginal cyst, assessment of the lesion via history taking and pelvic examination is important to confirm both lesion size and location. Perineal ultrasonography performed with an empty bladder is useful to differentiate such vaginal cysts and to define their communication, if any, with adjacent organs.

Three-Dimensional Dosimetry of the Full and Empty Bladder in High Dose Rate Vaginal Cuff Brachytherapy

ObjectivesThe objectives of the study were to assess the bladder doses during vaginal cuff brachytherapy and to examine the effect of bladder filling on normal tissue dosimetry by means of computed tomography.Materials and MethodsA total number of 45 women were enrolled in a prospective clinical trial. Patients were treated with the application of a single-line source vaginal cylinder. All the patients were asked to consume 400 mL of water 40 minutes before computed tomography scans were taken. For each patient, 2 treatment plans were performed—one with full bladder and the other one when the bladder was emptied. A dose-volume histogram and the equivalent of 2-Gy dose for full and empty bladder were calculated. Doses to the bowels in 2 states of the bladder were estimated.ResultsThirty-five patients received a lower dose to the empty bladder than to the filled organ. The average dose difference was 0.5 Gy. Ten patients received a lower dose to the full bladder than to the empty one. However, in this case, the difference amounted only to 0.2 Gy on average. Dose parameters (the maximal dose received by 0.1 cm3 of tissue and the maximal dose received by 2 cm3 of tissue) were lower in the empty state, but the volumetric parameters (the percent of bladder volume receiving ≥50% of the prescribed dose and the percent of bladder volume receiving ≥80% of the prescribed dose) were higher in the empty state of the bladder. Doses to the bowels seemed to be higher in the empty bladder. However, none of the doses exceeded the limitations.ConclusionsThe results have shown that in most cases, the dose to the empty bladder is lower than when the bladder is full. Simultaneously, the doses to the bowels increase proportionally in the empty state of the bladder comparing to the full organ. Protection of the bowels, which are more radiosensitive, suggests treating the patients in the full state of the bladder. Early and late bowel toxicity should be investigated to establish clear standards of treatment.