Bladder Trabeculation and Bladder Outlet Obstruction

Bladder trabeculation occurs when the muscles of the bladder wall thicken due to repeated urethral blockages. This causes the bladder to become less able to expand when full and contract when emptying. This can lead to a slowed urine flow, urination frequency, or a feeling that the bladder is not completely empty. This condition usually affects men over 50 and is often caused by enlarged prostate (BPH). It can also occur after laser treatment for BPH. Women can have bladder trabeculation caused by severe pelvic organ prolapse.

The goal of this study was to verify the correlation between trabeculation on cystography and bladder outlet obstruction as seen on urodynamic studies. This was accomplished by comparing the trabeculation grades on fluoroscopic images and evaluating their interobserver and test-retest reliability. The trabeculation grading was defined as follows: Grade 0 (none); Grade 1 (mild, depth 5 mm and covering 1/2 of the bladder surface); Grade 2 (moderate, depth 5-10 mm and covering >1/2 of the bladder surface); and Grade 3 (severe, depth >10 mm and area >=1/2 of the bladder surface).

In this study, VCUG had a moderate sensitivity (83.3%) but low specificity (30%) to reliably predict bladder trabeculation and voiding-related parameters. This is consistent with a previous study where they found that sonography has a poor sensitivity (27.3%) and cannot reliably rule out trabeculation on endoscopy in children with neurogenic bladder following spinal cord injury. Therefore, it is recommended that cystoscopy should be used to assess the presence of trabeculation on a child's VCUG or ultrasound examination.