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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Urinary tract
56
Bladder volume and residual volume
PREPARATION
Patient must have a full bladder.
POSITION
Supine.
TRANSDUCER
3.0–6.0 MHz curvilinear transducer.
METHOD
Transverse plane for the width depth and then a longitudinal image
provides the length measurement. Measurements are estimated both
pre- and post-micturition.
APPEARANCE
When full, the bladder is clearly dened as an almost square structure of low reectivity in the transverse plane. Within the bladder the
trigone is the area containing the ureteric and urethral orices. The
urethral orice marks the bladder neck.
MEASUREMENTS
The normal bladder volume when full is approximately 400–500 ml.
Bladder Volume (ml) =
π × Length × Depth × Width
6
(π/6 may be substituted by 0.52)
The accuracy of this calculation is variable, as it is based on an ellip-
soid formula, and there is considerable bladder shape variation. At
least 200 ml of uid must be in the bladder to make an urodynamic
ow rate study accurate. The normal residual post-micturition volume
is < 12 ml in 100% and < 5 ml in 78% of patients. A volume of > 50
ml is usually clinically signicant. If there remains a > 100 ml residual
volume, the patient should attempt further bladder emptying and the
examination should be repeated.
FURTHER READING
Grifths CJ, Murray A, Ramsden PD. Accuracy and repeatability of
bladder volume measurement using ultrasonic imaging. J Urol.
1986; 136:808–812.
Bladder volume and residual volume
A transverse image through the bladder with an almost square appearance of a full bladder
with measurement cursors in position measuring depth and width.
57
A longitudinal image through the bladder with measurement cursors in position measuring
length.
Urinary tract
58
Manieri C, Carter SS, Romano G, Trucchi A, Valenti M, Tubaro
A. The diagnosis of bladder outlet obstruction in men by
ultrasound measurement of bladder wall thickness. J Urol. 1998;
159;761–765.
McLean GK, Edell SL. Determination of bladder volumes by gray
scale ultrasonography. Radiology. 1978; 128:181–182.
Poston GJ, Joseph AE, Riddle PR. The accuracy of ultrasound in
the measurement of changes in bladder volume. Br J Urol. 1983;
55:361–363.
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Urinary tract
60
Bladder wall
PREPARATION
Patient must have a full bladder.
POSITION
Supine.
TRANSDUCER
3.0–6.0 MHz curvilinear transducer.
METHOD
Bladder wall is measured on transverse and longitudinal images by
placing the transducer in the midline above the pubis. The optimal
sites for measurement are the bladder oor lateral to the trigone on
transverse views and the posterior inferior wall on sagittal views.
APPEARANCE
Smooth contour with the high-reective mucosa distinguishable from
the low reective detrusor muscle.
The bladder wall is measured posteriorly at an optimal position.
Bladder wall
MEASUREMENTS
Detrusor wall thickness decreases continuously while the bladder lls
to 50% of its capacity, usually 250 ml, but then stays constant until
lled to 100% capacity. Therefore, measurements should be made
when the bladder is full.
Men tend to have a fractionally greater bladder wall thickness.
Regardless of the patient’s age and body mass index:
Normal empty bladder ≤ 5 mm
Well distended bladder < 2 mm
Global thickening > 5 mm can be a sign of bladder outlet obstruction.
FURTHER READING
Jequier S, Rousseau O. Sonographic measurements of the normal
bladder wall in children. AJR Am J Roentgenol. 1987;
149:563–566.
Manieri C, Carter SSC, Romano G, Trucchi A, Valenti M, Tubaro
A. The diagnosis of bladder outlet obstruction in men by
ultrasound measurement of bladder wall thickness. J Urol. 1998;
159:761–765.
Oelke M, Höfner K, Wiese B, Grünewald V, Jonas U. Increase in
detrusor wall thickness indicates bladder outlet obstruction in
men. World J Urol. 2002; 19:443–452.
61
Urinary tract
62
Functional bladder imaging
PREPARATION
The bladder should ideally be comfortably full but distended to <
600ml to prevent overstretching.
POSITION
Supine for ultrasound imaging. Standing or sitting for ow-rate analysis.
TRANSDUCER
3.0–6.0 MHz curvilinear transducer. A ow meter is required.
METHOD
Combination of bladder ultrasound with ow-rate measurement to
analyze bladder function.
After measuring the full bladder capacity and wall thickness, the ow
rate can be measured using a ow meter, which records the volume of
urine expelled per unit time (ml/s). The patient should be made comfortable for accurate physiological measurements.
A post-micturition volume should then be measured to document
residual volumes; a second postvoid residual may be necessary.
APPEARANCE
No imaging needed, except to conrm adequate prevoiding volume
and residual postvoiding volume.
MEASUREMENTS
The total voided volume should be at least 150 ml for accurate owmetry.
Functional bladder imaging
Normal ow pattern
Bladder capacity 400–500 ml male
350–500 ml female
Maximal ow rate 15 ml/s
>15 ml/s male > 60 years
>25 ml/s male < 40 years
30–50 ml/s female
Average ow rate 10 ml/s
Time to maximal ow 10 s or < 1/3 total ow time
Flow time 30 s
Voiding pressure 40–50 cm H
30–40 cm H
Post-void residual < 25 ml
FURTHER READING
Sahdev A. Functional imaging of the bladder. Imaging. 2008;
20:147–154.
0 male
2
0 female
2
63
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ORGAN
3
TRANSPLANTATION
Anu E. Obaro, Venus
Hedayati, ColinR. Deane,
KeshthraSatchithananda, and
PaulS.Sidhu
Liver transplantation 66
Renal transplantation 70
Renal artery stenosis in
transplantation 74
Pancreas transplantation 78