Noninvasive assessment of detrusor pressure and dysfunction

下尿路症状在成年男性和女性中非常普遍，估计患病率为 高达50%，并可能对生活质量产生重大影响。尿动力学检查(UDS)是常规的 在评估下尿路症状时进行。目前，UDS已广泛应用于临床 逼尿肌过度活动。逼尿肌过度活动是由无意的膀胱短暂收缩引起的。 逼尿肌，增加膀胱内压。逼尿肌过度活动是一个常见的问题。它 据估计，20%的总人口患有过度活跃的膀胱，而那些过度活跃的人 经UDS检查的患者中，65%的患者存在逼尿肌过度活动。UDS的另一个应用是评估 良性前列腺增生症(BPH)患者的膀胱功能前列腺增生症是一种常见的临床疾病。数以百万计 男性会出现下尿路症状，并为此寻求治疗。手术疏通大脑前路 可以通过尿路来治疗这些患者。临床上，UDS测试包括使用多个压力 导尿管(放置在膀胱和直肠/阴道内)，逆行膀胱充盈用于评估尿路 储存功能，以及压力-流量研究，以评估排空期的异常。UDS受到以下限制 它的侵袭性、患者不适、测试伪影和并发症的风险。不良后果， 包括尿潴留、导尿管损伤或血尿，据报道，高达19%的男性和1.8%的男性 女人。考虑到UDS的局限性，需要一种非侵入性的替代UDS。要克服这个问题 针对UDS的局限性，我们提出了一种非侵入性超声技术--定量超声膀胱 振动法(QUBV)。这项技术测量了逼尿肌过度活动引起的逼尿肌压力的变化。 由于这种方法不需要导尿，它不会使患者暴露在风险和不适中 与UDS关联。QUBV的其他优点包括直接测量逼尿肌压力，而不需要 碗收缩的影响，低成本，和便携性。此外，由于QUBV是非侵入性的，成本低，它是 适用于反复纵向试验，用于监测和评估治疗反应。这样做的目的是 该项目旨在评估QUBV应用于逼尿肌过度活动和BPH的疗效。为了实现我们的目标， 我们提出了以下具体目标：(1)评价定量超声膀胱的性能 振动测定法(QUBV)诊断逼尿肌过度活动；(2)预测性测定和监测 前列腺增生症患者可能受益于手术疏通尿路。每个目标都将是 在一群患者中进行了测试。我们的团队在开发新技术方面有十多年的经验 在泌尿外科的应用，因此拥有专业知识和资源，以实现该项目的目标。另外， 该项目受益于梅奥诊所的世界级临床研究和设施。成功完成 该项目可能会对膀胱功能障碍的诊断和治疗产生重大影响。

Lower urinary tract symptoms are highly prevalent in adult men and women, with an estimated prevalence of up to 50%, and can have a significant impact on quality of life. Urodynamic studies (UDS) are routinely performed in the assessment of lower urinary tract symptoms. Presently, UDS is used in the clinic to detect detrusor overactivity. Detrusor overactivity is caused by unintentional transient contraction of the bladder detrusor muscle, increasing the internal pressure in the bladder. Detrusor overactivity is a common problem. It is estimated that 20% of the total population suffer from overactive bladder, and of those with overactive bladder who are tested by UDS, 65% have detrusor overactivity. Another application of UDS is to assess bladder function in men with benign prostatic hyperplasia (BPH). BPH is a common clinical entity. Millions of men develop lower urinary tract symptoms and seek treatment for this entity. Surgery to de-obstruct the urinary tract may be pursued to treat these patients. Clinically, a UDS test includes the use of multiple pressure catheters (placed in the bladder and rectum/vagina), retrograde bladder filling for an assessment of urinary storage function, and a pressure-flow study to assess for abnormalities of the voiding phase. UDS is limited by its invasiveness, patient discomfort, testing artifacts, and the risk of complications. Adverse outcomes, including urinary retention, catheter trauma, or hematuria, are reported in up to 19% of men and 1.8% of women. Considering UDS limitations, there is a need for a noninvasive alternative to UDS. To overcome the limitations of UDS, we propose a noninvasive ultrasound technique, Quantitative Ultrasound Bladder Vibrometry (QUBV). This technique measures changes in the detrusor’s pressure due to detrusor overactivity. Since this method does not require catheterization, it does not expose the patients to the risks and discomfort associated with UDS. Other advantages of QUBV include a direct measure of the detrusor pressure without the influence of bowl contractions, low cost, and portability. Also, since QUBV is noninvasive and low cost, it is suitable for repeated longitudinal tests for monitoring and evaluating response to treatment. The goal of this project is to evaluate the efficacy of QUBV applications in detrusor overactivity and BPH. To achieve our goal, we propose the following Specific Aims: (1) Evaluate the performance of quantitative ultrasound bladder vibrometry (QUBV) in diagnosing detrusor overactivity; (2) Prognostically determine and monitor patients with BPH that may benefit from surgery to de-obstruct the urinary tract. Each Aims will be tested in a population of patients. Our team has over a decade of experience in developing new technology for application in urology, thus has the expertise and resources to achieve the goals of this project. Also, the project benefits from the world-class clinical research and facilities at the Mayo Clinic. Successful completion of this project may have a significant impact on the diagnosis and management of bladder dysfunction.