Turgut YAPANOĞLU, Ulaş TOKTAŞ, HÜSEYİN KOCATÜRK, YILMAZ AKSOY, İsa ÖZBEY

Mesane çıkım obstrüksiyonunun değerlendirilmesinde mesane duvar kalınlığının ölçümü

Bu çalışmada mesane çıkım obstrüksiyonu olan hastalarda çıkım obstrüksiyonunu göstermek için invaziv yöntem olan basınç-akım çalışmasının yerine non-invaziv yöntem olan mesane duvar kalınlığı ölçümünün kullanıla-bileceğini göstermeyi amaçladık. Çalışmaya 40 yaş üzeri, mesane çıkım obstrüksiyonu olan 12 hasta ve çıkım obstrüksi-yonu olmayan 9 hasta alındı. Hastalarda obstrüksiyon tanısı basınç-akım çalışması ile konuldu. Mesane duvar kalınlıkları 150 mL, 250 mL, 350 mL’deki mesane volümlerinde transabdominal ultrasonografi ile saptandı. Mesane duvar kalınlığı obstrüktif grupta 150 mL mesane hacminde 5.70 ± 0.59 mm (4.6-7.0 mm), 250 mL hacminde 4.46 ± 0.55 mm (3.4-5.2 mm), 350 mL mesane hacminde 3.37 ± 0.64 mm (2.8-4.6 mm) olarak saptandı. Non-obstrüktif grupta ortalama mesane duvar kalınlıkları 150 mL mesane hacminde 4.40 ± 0.54 mm (3.2-5.0 mm), 250 mL’de 3.35 ± 0.60 mm (2.1-4.2 mm), 350 mL mesane hacminde 2.68 ± 0.37 mm (2.2-3.4 mm) olarak elde edildi. Her iki grubun karşılaştırılmasında obstrüktif grubun mesane duvar kalınlığının her üç mesane hacminde de non-obstrüktif gruptan anlamlı şekilde daha fazla olduğu gösterildi (p

Anahtar Kelimeler:

Basınç, Mesane, Ultrasonografi, Mesane boyun tıkanıklığı

The use of bladder wall thickness in evaluation of bladder outlet obstruction

The aim of this study is to determine whether bladder wall thickness, a noninvasive method, can show bladder outlet obstruction or not. For this reason, bladder wall thickness was compared to pressure-flow study, an invasive method. 21 patients, all of them over 40 years old, 12 with bladder outlet obstruction and 9 without obstruction, included to the study. Bladder outlet obstruction was confirmed with pressure-flow study. Bladder wall thickness of all patients measured each time with transabdominal ultrasonography when their bladders were filled with 150 mL, 250 mL, and 350 mL volumes. Bladder wall thickness measurements in obstructive group with 150 mL, 250 mL, 350 mL bladder volumes are 5.70 ± 0.59 mm (4.6-7.0 mm), 4.46 ± 0.55 mm (3.4-5.2 mm), 3.37 ± 0.64 mm (2.8-4.6) respectively. Bladder wall thickness measurements in nonobstructive group with 150 mL, 250 mL, 350 mL bladder volumes were 4.40 ± 0.54 mm (3.2-5.0mm), 3.35 ± 0.60 mm (2.1-4.2 mm), 2.68 ± 0.37 mm (2.2-3.4 mm) in respectively. During comparison of two groups, bladder wall in obstructive group measured was thicker than nonobstructive group in each volumes (p<0.005). Non-invasive bladder wall tickness measurement may be used on be half of invasive pressure-flow studies. But in order to comparison of these two methods, normal reference ranges of bladder wall thickness obtained from healty people can be determined.

Keywords:

Pressure, Urinary Bladder, Ultrasonography, Urinary Bladder Neck Obstruction,

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1.Oelke M, Höfner K, Wiese B, et al: Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol, 19: 443-52, 2002.
2.Mattiasson A, Uvelius B: Changes in contractile properties in hypertrophic rat urinary bladder. J Urol, 128: 1340-1342, 1982.
3.Levin RM, Haugaard N, O'Connor L, et al: Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: a direct comparison. Neurourol Urodyn, 19: 609-629, 2000.
4.Hakenberg OW, Linne C, Manseck A, et al: Bladder wall thickness in normal adults and men with mild lower urinary tract symptoms and benign prostatic enlargement. Neurourol Urodyn, 19: 585-593, 2000.
5.Manieri C, Carter SS, Romano G, et al: The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J Urol, 159:761-765,1998.
6.Belal M, Abrams P: Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: Nonurodynamic approach. J Urol, 176: 22-28, 2006.
7.Klingler HC, Madersbacher S, Djavan B, et al: Morbidity of the evaluation of the lower urinary tract with transurethral multichannel pressure-flow studies. J Urol, 159: 191-194, 1998.
8.Kojima M, Inui E, Ochiai A, et al: Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology, 47: 942-947, 1996.
9.Schröder A, Chichester P, Kogan BA, et al: Effect of chronic bladder outlet obstruction on blood flow of the rabbit bladder. J Urol, 165: 640-6, 2001.
10.Oelke M, Höfner K, Jonas U, et al: Ultrasound measurement of detrusor wall thickness in healthy adults. Neurourol Urodyn, 25: 308-317, 2006.
11.Gilpin SA, Gosling JA, Barnard RJ: Morphological and morphometric studies of the human obstructed, trabeculated urinary bladder. Br J Urol, 57: 525-529, 1985.
12.Emberton M, Andriole GL, de la Rosette J, et al: Benign prostatic hyperplasia: a progressive disease of aging men Urology, 61: 267-73, 2003.
13.Oelke M, Höfner K, Jonas U, et al: Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol, 52: 827-834, 2007.
14.Nitti VW: Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol, 6: 14-21, 2005.
15.Schoor RA, Canning DA, Bella RD, et al: Ultrasound diagnosis of bladder outlet obstruction in rabbits Neurourol Urodyn, 13: 559-569, 1994.
16.Müller L, Jacobsson B, Mårild S, et al: Detrusor thickness in healthy children assessed by a standardized ultrasound method. J Urol, 166: 2364-2367, 2001.
17.Kessler TM, Gerber R, Burkhard FC, et al: Ultrasound assessment of detrusor thickness in men-can it predict bladder outlet obstruction and replace pressure flow study? J Urol, 175: 2170-2173, 2006.
18.Harris RA, Follett DH, Halliwell M, et al: Ultimate limits in ultrasonic imaging resolution. Ultrasound Med Biol, 17: 547-558, 1991.