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NEAR INFRARED SPECTROSCOPY (NIRS); MATHEMATICAL MODELING OF DETRUSOR HAEMOGLOBIN CONCENTRATION AND URODYNAMIC PRESSURES IN WOMEN
Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008
THE JOURNAL OF UROLOGY®
517
CONCLUSIONS: fNIRS of the human bladder is feasible. The changes in O2HB and HHb seen are consistent with graphic display data from previous studies. However, the dynamic nature of the colour mapping technique provides physiologic information over a larger surface area than standard NIRS, and offers the potential to investigate regional variations in O2HB and HHb in the detrusor during voiding. Source of Funding: None
Source of Funding: Oxford Health Services Research Committee, Oxford, UK.
1517 FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (fNIRS); DYNAMIC TOPOGRAPHIC MAPPING OF THE HUMAN BLADDER DURING VOIDING Lynn Stothers, Andrew Macnab*, Babak Shadgan. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a non-invasive means of measuring changes in concentration of the chromophores deoxyhaemoglobin (HHb), oxyhaemoglobin (O2HB) and Cytochrome aa3 (Cyt) in real time. Functional NIRS (fNIRS) maps multiple sites over a geographic area displaying dynamic changes in chromophore concentration in a colour video format. The objective of the study was to demonstrate the feasibility of using fNIRS to monitor topographic changes in concentration of O2HB and HHb in the detrusor of asymptomatic adults during natural voiding. METHODS: 6 adult male and 6 adult female volunteers age 45 - 64 participated. There was no history of urinary tract symptoms, D QRUPDO ÀRZ SDWWHUQ IRU DJH DQG D UHVLGXDO XULQH PHDVXUHPHQW E\ XOWUDVRXQGRIOHVVWKDQFF'XULQJ¿OOLQJWKHVXEMHFWOD\VXSLQHDQG was provided water ad lib until bladder capacity was reached. A 2 channel, 4 point NIRS array (4 by 4 cm) was placed on the skin, and its VXSUDSXELFSRVLWLRQUHODWLYHWRWKHIXOOEODGGHUFRQ¿UPHGZLWKXOWUDVRXQG 6LPXOWDQHRXVXURÀRZLQWRDÀRZPHWHUDQGI1,56WRSRJUDSKLFPDSSLQJ of chromophore concentration were recorded in real time during voiding while standing, with data displayed as colour video images and conventional line graphics. RESULTS: During voiding graphic display of NIRS changes in chromophore concentration from baseline show an increase in total haemoglobin following permission to void, followed by a decline to a nadir SULRUWRFHVVDWLRQRIXURÀRZ7KLVFKDQJHLQWRWDOKDHPRJORELQLVODUJHO\ due to an increase in O2HB. Topographic mapping shows the dynamic variation in O2HB 5 and HHb of 5 micromole change from baseline throughout the voiding cycle. Three or greater regional foci of variation occur per subject. Example still images from the colour video of O2Hb at the start, Qmax and end of voiding are shown below.
1518 NEAR INFRARED SPECTROSCOPY (NIRS); MATHEMATICAL MODELING OF DETRUSOR HAEMOGLOBIN CONCENTRATION AND URODYNAMIC PRESSURES IN WOMEN Lynn Stothers, Andrew Macnab*. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a transcutaneous monitoring tool using light in the near infrared region to monitor changes in the chromophore concentrations of oxygenated (O2Hb) and de-oxygenated (HHb) haemoglobin distribution within the detrusor. The objective was to mathematically model NIRS parameters in relation to urodynamic pressures. METHODS: 24 females, (aged 23 to 84) presenting with lower urinary tract symptoms (LUTS) participated. History was documented using the urogenital distress inventory and pelvic exam was performed to record pelvic organ prolapse. Complete pelvic ultrasound of bladder anatomy in the supine, upright and sitting positions was completed. Patients underwent multichannel urodynamics (UDS) and simultaneous 1,56GDWDFROOHFWLRQDW+]LQWHUYDOV8'6LQFOXGHGQRQLQYDVLYHXURÀRZ IROORZHGE\WZR¿OOLQJF\VWRPHWURJUDPVDQGWZRSUHVVXUHÀRZVWXGLHVSHU VXEMHFWXVLQJD¿OOLQJUDWHRIDPOPLQZLWKVWHULOHZDWHUDQGIUHQFK catheters. Mathematical modeling included: coherence analysis, spectral analysis to detect intrinsic frequencies and phase synchrony analysis (range 0-1) using MATLAB software. RESULTS: Of the 24 women, 12 had detrusor overactivity, 6 had mixed incontinence and 6 had stress incontinence. There was no F\VWRFHOHLQDQGJUDGHF\VWRFHOHLQZRPHQ8OWUDVRXQGFRQ¿UPHG the position of the optodes over the bladder in the supine, upright and VLWWLQJSRVLWLRQV7KHV\QFKURQL]DWLRQLQGH[WKURXJKRXW¿OOLQJDQGYRLGLQJ was 0.7 for O2Hb to Pdet, 0.6 for HHb to Pdet, 0.6 for O2Hb to Pves, 0.6 for HHb to Pves and 0.7 for O2Hb to HHb. In particular, frequency and pattern analysis demonstrated concordant changes in O2Hb to Pdet in 82% of patients studied. CONCLUSIONS: Mathematical modeling showed synchrony between NIRS chromophore concentrations and urodynamic pressures with the greatest synchrony between O2Hb and Pdet. The concordant patterns observed during voiding indicate good statistical correlation between NIRS parameters and urodynamic pressures. Source of Funding: Canadian Institutes of Health Research and The National Research Council Canada - Industrial Research Assistance Program (NRC-IRAP).
1519 TRANSVAGINAL NEAR-INFRARED SPECTROSCOPY (NIRS) OF THE FEMALE MID URETHRA DURING VOIDING AND PELVIC FLOOR EXERCISE Andrew Macnab*, Lynn Stothers, Babak Shadgan. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a transcutaneous monitoring tool using light
THE JOURNAL OF UROLOGY®
517
CONCLUSIONS: fNIRS of the human bladder is feasible. The changes in O2HB and HHb seen are consistent with graphic display data from previous studies. However, the dynamic nature of the colour mapping technique provides physiologic information over a larger surface area than standard NIRS, and offers the potential to investigate regional variations in O2HB and HHb in the detrusor during voiding. Source of Funding: None
Source of Funding: Oxford Health Services Research Committee, Oxford, UK.
1517 FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (fNIRS); DYNAMIC TOPOGRAPHIC MAPPING OF THE HUMAN BLADDER DURING VOIDING Lynn Stothers, Andrew Macnab*, Babak Shadgan. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a non-invasive means of measuring changes in concentration of the chromophores deoxyhaemoglobin (HHb), oxyhaemoglobin (O2HB) and Cytochrome aa3 (Cyt) in real time. Functional NIRS (fNIRS) maps multiple sites over a geographic area displaying dynamic changes in chromophore concentration in a colour video format. The objective of the study was to demonstrate the feasibility of using fNIRS to monitor topographic changes in concentration of O2HB and HHb in the detrusor of asymptomatic adults during natural voiding. METHODS: 6 adult male and 6 adult female volunteers age 45 - 64 participated. There was no history of urinary tract symptoms, D QRUPDO ÀRZ SDWWHUQ IRU DJH DQG D UHVLGXDO XULQH PHDVXUHPHQW E\ XOWUDVRXQGRIOHVVWKDQFF'XULQJ¿OOLQJWKHVXEMHFWOD\VXSLQHDQG was provided water ad lib until bladder capacity was reached. A 2 channel, 4 point NIRS array (4 by 4 cm) was placed on the skin, and its VXSUDSXELFSRVLWLRQUHODWLYHWRWKHIXOOEODGGHUFRQ¿UPHGZLWKXOWUDVRXQG 6LPXOWDQHRXVXURÀRZLQWRDÀRZPHWHUDQGI1,56WRSRJUDSKLFPDSSLQJ of chromophore concentration were recorded in real time during voiding while standing, with data displayed as colour video images and conventional line graphics. RESULTS: During voiding graphic display of NIRS changes in chromophore concentration from baseline show an increase in total haemoglobin following permission to void, followed by a decline to a nadir SULRUWRFHVVDWLRQRIXURÀRZ7KLVFKDQJHLQWRWDOKDHPRJORELQLVODUJHO\ due to an increase in O2HB. Topographic mapping shows the dynamic variation in O2HB 5 and HHb of 5 micromole change from baseline throughout the voiding cycle. Three or greater regional foci of variation occur per subject. Example still images from the colour video of O2Hb at the start, Qmax and end of voiding are shown below.
1518 NEAR INFRARED SPECTROSCOPY (NIRS); MATHEMATICAL MODELING OF DETRUSOR HAEMOGLOBIN CONCENTRATION AND URODYNAMIC PRESSURES IN WOMEN Lynn Stothers, Andrew Macnab*. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a transcutaneous monitoring tool using light in the near infrared region to monitor changes in the chromophore concentrations of oxygenated (O2Hb) and de-oxygenated (HHb) haemoglobin distribution within the detrusor. The objective was to mathematically model NIRS parameters in relation to urodynamic pressures. METHODS: 24 females, (aged 23 to 84) presenting with lower urinary tract symptoms (LUTS) participated. History was documented using the urogenital distress inventory and pelvic exam was performed to record pelvic organ prolapse. Complete pelvic ultrasound of bladder anatomy in the supine, upright and sitting positions was completed. Patients underwent multichannel urodynamics (UDS) and simultaneous 1,56GDWDFROOHFWLRQDW+]LQWHUYDOV8'6LQFOXGHGQRQLQYDVLYHXURÀRZ IROORZHGE\WZR¿OOLQJF\VWRPHWURJUDPVDQGWZRSUHVVXUHÀRZVWXGLHVSHU VXEMHFWXVLQJD¿OOLQJUDWHRIDPOPLQZLWKVWHULOHZDWHUDQGIUHQFK catheters. Mathematical modeling included: coherence analysis, spectral analysis to detect intrinsic frequencies and phase synchrony analysis (range 0-1) using MATLAB software. RESULTS: Of the 24 women, 12 had detrusor overactivity, 6 had mixed incontinence and 6 had stress incontinence. There was no F\VWRFHOHLQDQGJUDGHF\VWRFHOHLQZRPHQ8OWUDVRXQGFRQ¿UPHG the position of the optodes over the bladder in the supine, upright and VLWWLQJSRVLWLRQV7KHV\QFKURQL]DWLRQLQGH[WKURXJKRXW¿OOLQJDQGYRLGLQJ was 0.7 for O2Hb to Pdet, 0.6 for HHb to Pdet, 0.6 for O2Hb to Pves, 0.6 for HHb to Pves and 0.7 for O2Hb to HHb. In particular, frequency and pattern analysis demonstrated concordant changes in O2Hb to Pdet in 82% of patients studied. CONCLUSIONS: Mathematical modeling showed synchrony between NIRS chromophore concentrations and urodynamic pressures with the greatest synchrony between O2Hb and Pdet. The concordant patterns observed during voiding indicate good statistical correlation between NIRS parameters and urodynamic pressures. Source of Funding: Canadian Institutes of Health Research and The National Research Council Canada - Industrial Research Assistance Program (NRC-IRAP).
1519 TRANSVAGINAL NEAR-INFRARED SPECTROSCOPY (NIRS) OF THE FEMALE MID URETHRA DURING VOIDING AND PELVIC FLOOR EXERCISE Andrew Macnab*, Lynn Stothers, Babak Shadgan. Vancouver, BC, Canada. INTRODUCTION AND OBJECTIVE: Near Infrared Spectroscopy (NIRS) is a transcutaneous monitoring tool using light