Urology

The urology department sees a wide range of patients with lower urinary tract symptoms following referral from primary care into the Acute environment for further diagnosis. Checking optimal bladder capacity prior to uro-dynamics, Trial without Catheter (TWOC), diagnosis of incontinence type, checking for significant post void residual volumes forms part of this diagnosis and all of which can be supported through the use of BladderScan®. To illustrate this, patients with benign prostatic hyperplasia (BPH)¹, prostate cancer, spinal cord injury, stroke, spina bifida and multiple sclerosis are examples of those who need ongoing assessment. Without BladderScan® these patients may be subjected to the trauma of unnecessary catheterisations and are at risk of a developing a catheter related urinary tract infection.

¹ The worldwide BPH market alone has roughly 23 million cases, with 20% seeking treatment (reference)

• Indications & Applications
• Cost Analysis
• Key Clinical Messages
• Literature

Indications / Applications

Indications for the use of the BladderScan® withing Urology are;

• Patient with a risk of urinary retention
• Patient who hasn't been able to urinate spontaneously for some time
• Patient after removal of an indwelling catheter
• Patient who is confused and restless
• Patient who isn't been able to tell you if he or she has been able to void
• Patient who requires bladder re-training following surgery or bladder dysfunction
• Patient with M.S.
• Patient with Parkinson disease

Benefits for the user of BaldderScan® include;

• Reduces use of unnecessary catheterisations
• Reduces use of unnecessary disposables
• Non-invasive
• Reduces incidence of urinary tract infection and associated costs
• Easy to use
• Saves staff time
• Cost-effective
• Eliminates unnecessary trauma to patients
• Non-real time allows focussed scanning
• In house product training is aligned to KSF requirements
• Can be used by any healthcare practitioner and applied to their clinical environment
• All products, accessories and consumables can be purchased through NHS Logistics On-Line

Cost Analysis

	Hospital - Cost Justification- Monthly Financed.pdf
	Hospital - Cost Justification-6100.pdf
	Hospital - Cost Justification-Multiple.pdf

Key Clinical Messages

Moore D. (2002 Journal of Nursing)
Using a portable BladderScan™ to reduce the incidence of nosocomial Urinary Tract Infections.
This paper demonstrates the speed, ease of use, cost effectiveness and accuracy of using a portable BladderScan to reduce the incidence of UTI's caused by urethral catheterisation. A comparison between catheterization and use of BladderScan is presented.

Coombes G.M. (1994 The Journal of Urology Vol. 152, 2083-2085)
The accuracy of portable ultrasound scanning in the measurement of residual urine volume.
This study shows a mean difference between catheter volume estimate, & true bladder volume of 25 ml. The accuracy of a BladderScan™ (BVI 2500) is as good as catheter estimations of true residual volumes and may certainly be used as an alternative to catheterization for the measurement & determination of residual urine volume. The gold standard of diagnostic catheterization now can be challenged.

Ding Y. et.al. (1996 Singapore M.J. 37(4) p. 365)
Clinical Utility of a Portable Ultrasound Scanner in the Measurement Residual Urine Volume
The mean absolute error of the scanner was 52 ml. For volumes below 200 ml and 100 ml, this was 36 ml. and 24 ml respectively. A decision regarding whether to decompress the bladder by catheterization would have also been correct in 86% to 89% of instances, depending on the cut-off value of the residual volume used. In other words, the ultrasound measurement would have been correct in 9 out of 10 clinical cases residual urine volumes in children with neurogenic bladder

Massagli T.L. Dept of Rehabilitation Medicine, Childrens Hospital and Medical Centre and University of Washington School of Medicine (1989 Journal of Urology vol. 142, pp. 989)
Experience with ultrasound equipment and measurement of urine volumes: Inter-user reliability and factors of patient position
Measurements made by an experienced examiner were compared to the true urine volume obtained by catheterization. Correlation was highly significant. Accuracy and precision of the ultrasound measurements were not affected by patient position. Thus, little training is necessary to use this instrument, interuser reliability is good, and accuracy and precision are clinically acceptable whether patients are in the seated or supine positions.

Marks L.S. et.al. (1997 et al Urology no 50: 341)
Three-Dimensional Ultrasound Device for Rapid Determination of Bladder Volume
Volume determinations obtained with the bladder scan device are accurate and reliable in adult outpatients. A special technician is not required. The results may be attributable to use of automated planimetry and 3-D volumetry, rather than a fixed geometric formula, to custom measure each bladder shape. According to one authority, ultrasonography has become an important extension of the urologic examination because it is quick, safe, non-invasive, relatively inexpensive, widely available, accurate and reliable. These attributes, along with convenience and ease of use, appear to apply to bladder volume determination with the present device.

Ireton R.C. et.al. from the Departments of Urology and Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (1990 J. Urol. 143:909-911)
Bladder volume Determination using a dedicated, portable Ultrasound Scanner
Urethral catheterization is associated with patient discomfort plus the risks of urethral trauma and urinary tract infection. A portable ultrasound instrument that automatically determines bladder volume was used for 164 determinations and the digital readout correlated with the catheterized volume (r2 equals 0.79). This instrument is a noninvasive alternative to urethral catheterization for the determination of bladder volume in most patients.

Fuse H. (1996 Int. Urol. and Nephrology 28 (5) pp.633-637)
Measurement of Residual Urine Volume Using a Portable Ultrasound Instrument.
A portable ultrasound unit has been developed which offers a non invasive procedure to determine urine volume. This study was undertaken to evaluate the accuracy of measurements by this method. A high correlation was demonstrated between the catheterized volume and ultrasound estimation (r²=0,98, p<0.0001). In patients with residual of >50 ml, the unit could correctly identify 93%. This instrument is useful in estimating the residual urine volume, and its application is recommended as an alternative to catheterization.

McCliment J. (2002 Contempory LTC)
Non-invasive method overcomes incontinence.
Program retrains residents to recognize the urge to void.

Seung-June ( 2002 Int. Continence Society 32nd Annual Meeting Heidelberg, Germany, 28-30, Oral Submission)
Accuracy of ultrasound determinations of the bladder volume in the patients with voiding dysfunction: Are the accurate in all ranges of possible volume?
There is still no agreement on whether the ultrasound measurements of the bladder volume are reproducible and reliable in all ranges of possible bladder volume. We investigate the accuracy of both portable 3D scanner and 2-D conventional equipment in estimating the selected bladder volumes. Our results demonstrated the a 3-D hand held scanner (BladderScan) measures bladder volume in a reproducible and accurate manner, being superior to the 2-D stationary ultrasound. We concluded a 3-D bladder scanner a reliable applicable in determining the wide range of bladder volume.

Urology Literature References