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。尿动力学研究（UDS）是常规的 在下尿路症状的评估中进行。目前，UDS用于临床检测 逼尿肌过度活动逼尿肌过度活动是由膀胱无意的短暂收缩引起的 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%的总人口患有膀胱过度活动症， 膀胱逼尿肌功能亢进者占65%。UDS的另一个应用是评估 前列腺增生症（BPH）患者的膀胱功能。BPH是一种常见的临床疾病。数百万 男性出现下尿路症状并寻求治疗。手术疏通 泌尿道可以追求治疗这些患者。临床上，UDS测试包括使用多个压力 导管（放置在膀胱和直肠/阴道中），逆行膀胱充盈，用于评估尿 储存功能，以及压力-流量研究，以评估排尿期的异常。UDS受限于 其侵入性、患者不适、测试伪影和并发症风险。不良后果， 包括尿潴留、导尿管损伤或血尿，据报道，19%的男性和1.8%的 妇女考虑到UDS的局限性，需要一种非侵入性的UDS替代品。克服 UDS的局限性，我们提出了一种无创超声技术，定量超声膀胱 振动测量（QUBV）。该技术测量由于逼尿肌过度活动引起的逼尿肌压力变化。 由于这种方法不需要导管插入，因此不会使患者暴露于风险和不适 与UDS有关。QUBV的其他优点包括直接测量逼尿肌压力， 碗收缩的影响、低成本和便携性。此外，由于QUBV是非侵入性的且成本低， 适用于重复的纵向测试，以监测和评估对治疗的反应。这个目标 该项目旨在评估QUBV应用在逼尿肌过度活动和BPH中的疗效。为了实现我们的目标， 本研究的具体目的如下：（1）评价膀胱定量超声的性能 振动仪（QUBV）诊断逼尿肌过度活动;（2）预测和监测 可能受益于手术疏通尿路的BPH患者。每个目标将是 在一群病人中进行测试。我们的团队在开发新技术方面拥有十多年的经验， 在泌尿外科的应用，因此有专业知识和资源，以实现这一项目的目标。还 该项目得益于马约诊所世界一流的临床研究和设施。成功完成 该项目可能对膀胱功能障碍的诊断和管理产生重大影响。

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.