以經陰道超音波彈性影像測量膀胱疼痛症候群女性病患膀胱逼尿肌組織硬度

初步研究報告

瞿琤¹、林志杰^1,2、王信凱³、黃志賢^1,2、林登龍^1,2

臺北榮民總醫院 泌尿部¹；國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心²

臺北榮民總醫院 放射線部³；

Transvaginal Ultrasound Shear Wave Elastography to Evaluate Detrusor Wall of Bladder Pain Syndrome in Women: A Preliminary Report

Cheng Chu¹, Chih-Chieh Lin^1,2, Hsin-Kai Wang³, William J. Huang^1,2, Alex T.L. Lin^1,2

Department of Urology, Taipei Veterans General Hospital¹

Department of Urology, School of Medicine and Shu-Tien Urological Research Center,

National Yang-Ming University, Taipei, Taiwan²

Department of Radiology, Taipei Veterans General Hospital³

Purpose:

Interstitial cystitis (IC) /bladder pain syndrome (BPS) was defined as a clinical diagnosis based on urgency, frequency and pain in the bladder and/or pelvis. Although urodynamic study is not essential for diagnosis of IC/BPS, several studies have used urodynamic study to evaluate bladder dysfunction in those patients. The interactions between the detrusor muscle and other interstitial cells contributing to coordinating and modulating detrusor contractions are still unclear. The aim of this study was to investigate the correlation between the thickness and stiffness (measured by shear wave velocity) of detrusor muscle, both measured by transvaginal ultrasonography, in women with bladder pain syndrome (BPS) under different degree of bladder filling.

Materials and Methods:

Patients diagnosed with BPS according to the 2014 American Urological Association (AUA) criteria between October of 2019 and March of 2020 were prospectively recruited. 10 women had been diagnosed with BPS and 18 women without BPS. All patients had been diagnosed with PBS based on clinical features before cystoscopy, potassium sensitivity test and urodynamic study. 7 women with detrusor normoreflexia, 6 women with detrusor overactivity and 15 women with detrusor underactivity (DU) were identified by urodynamic investigation. Transvaginal ultrasound was performed by using an ultrasound machine (Aplio i-Series A800, Canon Medical System) with a transcavitary curvilinear probe (3 to 11 mHz) equipped with shear wave velocity. Detrusor wall thickness (DWT) and shear wave velocity of posterior bladder wall were acquired sequentially starting from empty bladder, different degree of bladder filling (50ml, 100ml, 150ml, 200ml), and once again empty bladder. An independent t-test was used for comparing two groups (with/without BPS) under different bladder volume. Two-tailed p value of less than 0.05 was considered statistically significant.

Results:

All women were normal compliance of urinary bladder. Urodynamic study of BPS women included 3 with detrusor normoreflexia, 2 with detrusor overactivity and 5 with DU. DWT decreased and mean shear wave velocity increased were noted during the bladder filling. In all BPS women, detrusor muscle sonography and elastography were similar to detrusor normoreflexia/ without BPS group (fig 1). Comparing detrusor wall elastography, DU with BPS women had softer detrusor wall than DU without BPS.

Conclusion:

Both mean DWT of with/without BPS groups became thinner under bladder distention. In our shear wave elastography study, BPS bladder are indistinguishable from the normal bladder.