Conforming an Extracorporeal Lithotripter System for Video Urodynamic Studies

Ning Xiao1,2,3, Qi Tang2,3, Sheng Zhu2,3, GuangRong Guo1, LianHua Chen2,3, JianFeng Wang2,3, HuaSheng Zhao2,3

1Video Urodynamics Center, Department of Urology, The Second Affiliated Hospital of GuiLin Medical University, GuiLin, China

2Continence Research Clinic, The Central Hospital of ShaoYang, ShaoYang, China

3Department of Urology, ShaoYang Hosptial, affiliated to University of South China, ShaoYang, China

 

Correspondence to:  Ning Xiao; email: xy20001816@163.com

Received: 19 Apr 2021; Revised: 26 Oct 2021; Accepted: 27 Feb 2022; Available online: 25 Mar 2022

 

Abstract 

Objectives: This study aimed to evaluate the efficiency using existing fluoroscopic unit and lithotripter table of an extracorporeal lithotripter system for video urodynamic studies (VUDS) to determine anatomical abnormalities in patients with neurogenic lower urinary tract dysfunction (NLUTD). Methods: The extracorporeal lithotripsy system was adapted to obtain optimum fluoroscopic view according to body shape and observed organs of patients. We reviewed the VUDS data of 25 patients with NLUTD. Results: “Christmas tree bladder” (CTB) was found in 5 (20%) patients. Vesicoureteral reflux (VUR) and external detrusor sphincter dyssynergia (DESD) were detected in 3 (12%) and 4 (16%) patients, respectively. Four (16%) patients with normal coordination between detrusor contraction and external sphincter relaxation were proven by VUDS. CTB, VUR, or DESD was not observed in 10 (40%) patients with flaccid bladder. Hematuria, urinary tract infection, or autonomic dysreflexia did not occur in any of the patients. Conclusions: VUDS can discern anatomical abnormalities of the urinary tract, and patients in undeveloped areas of the world who have NLUTD can have easier access to VUDS because of the decreasing capital cost of VUDS.

 

Keywords: Video urodynamics, Neurogenic lower urinary tract dysfunction, Extracorporeal lithotripsy system, Set-up investment, Complications

 

Ann Afr Surg. 2022; 19(2): 94-99

DOI: http://dx.doi.org/10.4314/aas.v19i2.6

 

Funding: This study was supported by the Guangxi Science and Technology Base and Talents Program (no. AD20159008), the Scientific Research Project of Guangxi Health and Family Planning Commission (no. S2020105), and the Projects of Guiding Technological Innovation of HuNan Province (no. 2017SK51404).

 

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
 

Introduction 

Urodynamic test has been considered a “starting point” in the diagnosing lower urinary tract dysfunction (LUTD), which can lead to optimal and individual protocols for patients with LUTD (1). However, pivotal anatomical abnormalities of the urinary tract may be overlooked by conventional urodynamic studies (UDS), in which the function of lower urinary tract are evaluated by cystometry and pressure-flow study. Therefore, those radiologic images are used simultaneously during conventional UDS to determine anatomical abnormalities of the urinary tract according to its function (2). In 1980, video urodynamics studies (VUDS), in which UDS and fluoroscopic cystourethrographies were synchronously documented, were conducted to evaluate the complicated LUTD, including urinary incontinence, complex bladder outlet obstruction, and neurogenic bladder, in approximately 900 consecutive tests by Webster and Older (3). Given that both possible functional pathognomonic traits in cystometry and pressure-flow tests and morphological abnormalities in urinary tract were synchronously detected by VUDS, which can be utilized to prevent complications of neurogenic lower urinary tract dysfunction (NLUTD), including chronic kidney disease (CKD) and refractory urinary tract infections (UTI), it has been considered as the gold standard for NLUTD evaluation (4,5).

 

Although the combination of radiological C-arm and urological table is mostly used to generate synchronous fluoroscopic images of urinary tract in VUDS, the huge investment for VUDS set-up and facilities for radiation safety has hindered the popularization of VUDS in mainland China, except for a few neuro-urological centers in major metropolises, for example BeiJing, ZhengZhou, and GuangZhou (6,7). However, extensive utilization of extracorporeal lithotripter system (ECLS) is attributed to the high incide