Jae Hyun Jung1, Sung Yong Cho2, Changwon Yoo3, Seung-June Oh4. 1. Department of Urology, Seoul National University Hospital, Seoul, South Korea. 2. Department of Urology, SMG-SNU Boramae Medical Center, Seoul, South Korea. 3. Department of Biostatistics, Florida International University, Miami, FL. 4. Department of Urology, Seoul National University Hospital, Seoul, South Korea. Electronic address: sjo@snu.ac.kr.
Abstract
OBJECTIVE: To establish a cystoscopic grading system for trabeculation of neurogenic bladders. MATERIALS AND METHODS: A total of 140 neurogenic bladder patients who had undergone both fluoroscopic urodynamic study and cystoscopic examination were retrospectively reviewed. Cystoscopic images were categorized into 4 grades according to the formation of the muscle bundle layer and height-to-width ratio of the muscle bundle: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Test-retest reliability and interobserver reliability were assessed. Cystoscopic grade of the trabeculated bladder was correlated with urodynamic results and the fluoroscopic grades of trabeculation. RESULTS: The test-retest reliability showed almost perfect agreement with all levels of Cronbach alpha ranging from 0.925 to 0.970. The intraclass correlation coefficient was 0.986, indicative of an almost perfect level of interobserver reliability. The grading system showed clinical significance by correlation with urodynamic parameters (Qmax, P value = .016; postvoid residual, P value <.001; bladder outlet obstruction index, P value = .002). Cystoscopic grades correlated moderately well with fluoroscopic grades, showing comparable clinical significance with fluoroscopic grades. CONCLUSION: Our results showed that this novel cystoscopic classification of bladder trabeculation was highly reliable.
OBJECTIVE: To establish a cystoscopic grading system for trabeculation of neurogenic bladders. MATERIALS AND METHODS: A total of 140 neurogenic bladderpatients who had undergone both fluoroscopic urodynamic study and cystoscopic examination were retrospectively reviewed. Cystoscopic images were categorized into 4 grades according to the formation of the muscle bundle layer and height-to-width ratio of the muscle bundle: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Test-retest reliability and interobserver reliability were assessed. Cystoscopic grade of the trabeculated bladder was correlated with urodynamic results and the fluoroscopic grades of trabeculation. RESULTS: The test-retest reliability showed almost perfect agreement with all levels of Cronbach alpha ranging from 0.925 to 0.970. The intraclass correlation coefficient was 0.986, indicative of an almost perfect level of interobserver reliability. The grading system showed clinical significance by correlation with urodynamic parameters (Qmax, P value = .016; postvoid residual, P value <.001; bladder outlet obstruction index, P value = .002). Cystoscopic grades correlated moderately well with fluoroscopic grades, showing comparable clinical significance with fluoroscopic grades. CONCLUSION: Our results showed that this novel cystoscopic classification of bladder trabeculation was highly reliable.