Noninvasive assessment of detrusor pressure and dysfunction

无创评估逼尿肌压力和功能障碍

• 批准号: 10570230
• 负责人: Azra Alizad
• 金额: $ 61.34万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570230
• 关键词: Adult; Benign Prostatic Hypertrophy; Bladder; Bladder Dysfunction; Catheterization; Catheters; Clinic; Clinical; Clinical Research; Computer software; Development; Diagnosis; Elasticity; Environment; Evaluation; Frequencies; Functional disorder; Goals; Hematuria; Human; Intubation; Measurement; Measures; Methods; Monitor; Morphologic artifacts; Nature; Neurologic; Nocturia; Operative Surgical Procedures; Overactive Bladder; Patient Care; Patient Monitoring; Patients; Performance; Phase; Physiological; Population; Prevalence; Quality of life; Recommendation; Rectum; Reporting; Research; Resources; Risk; Selection for Treatments; Symptoms; Techniques; Technology; Testing; Therapeutic Intervention; Time; Translating; Translational Research; Trauma; Treatment Failure; Urinary Retention; Urinary tract; Urodynamics; Urology; Vagina; Woman; adverse outcome; clinical practice; cost; detection method; detrusor muscle; efficacy evaluation; experience; follow-up; in vivo; lower urinary tract symptoms; male; mechanical properties; men; micturition urgency; new technology; novel; novel diagnostics; patient population; portability; pressure; prognostication; prostate enlargement; quantitative ultrasound; rectal; response; therapy outcome; tool; treatment planning; treatment response; ultrasound; urinary; urologic

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.

下尿路症状在成年男性和女性中非常普遍，估计患病率 高达 50%，并且可以对生活质量产生重大影响，尿动力学研究 (UDS) 是常规检查。 用于评估下尿路症状 目前，UDS 在临床上用于检测。 逼尿肌过度活动是由膀胱无意识的短暂收缩引起的。 逼尿肌过度活动是常见的问题。 据估计，总人口中有 20% 患有膀胱过度活动症，其中膀胱过度活动症患者 通过 UDS 测试的膀胱患者中，65% 患有逼尿肌过度活动。 UDS 的另一个应用是评估。 良性前列腺增生（BPH）男性的膀胱功能是数以百万计的常见临床疾病。 男性出现下尿路症状并寻求手术治疗以解除阻塞。 临床上，UDS 测试包括使用多重压力来治疗这些患者。 导管（放置在膀胱和直肠/阴道），逆行膀胱充盈以评估尿 储存功能和评估排尿阶段异常的压力流量研究受到限制。 其侵入性、患者不适、测试伪影以及并发症的风险， 据报道，高达 19% 的男性和 1.8% 的女性出现尿潴留、导管创伤或血尿等症状。 考虑到 UDS 的局限性，需要一种 UDS 的非侵入性替代方案来克服这一问题。 针对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。 由于该方法不需要插管，因此不会使患者面临风险和不适 与 UDS 相关的 QUBV 的其他优点包括无需直接测量逼尿肌压力。 此外，由于 QUBV 是非侵入性的且成本低廉，因此它具有碗收缩的影响、低成本和便携性。 适合用于监测和评估治疗反应的重复纵向测试。 项目旨在评估 QUBV 应用在逼尿肌过度活动和 BPH 方面的功效，以实现我们的目标。 我们提出以下具体目标：（1）评估定量超声膀胱的性能 振动测量 (QUBV) 诊断逼尿肌过度活动 (2) 预后确定和监测； 可能受益于尿路梗阻手术的 BPH 患者。 我们的团队在开发新技术方面拥有十多年的经验。 在泌尿外科中的应用，因此拥有实现该项目目标的专业知识和资源。 项目受益于梅奥诊所世界一流的临床研究和设施的成功完成。 该项目可能对膀胱功能障碍的诊断和治疗产生重大影响。