Systematic review and meta-analysis of the accuracy of bladder wall thickness measurement for the diagnosis of detrusor overactivity in women

Lemmon B1, Patel M2, Tadros M1, Ruwan F1, Digesu A1, Bhide A1, Khullar V1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 150
Urogynaecology 4 - Female Lower Urinary Tract Symptoms
Scientific Podium Short Oral Session 13
Friday 19th September 2025
09:37 - 09:45
Parallel Hall 4
Detrusor Overactivity Imaging Urgency/Frequency
1. St Mary's Hospital, Imperial College Healthcare NHS Trust, 2. Kingston Hospital NHS Trust
Presenter
Links

Abstract

Hypothesis / aims of study
Urodynamic investigation remains the gold standard for assessment of lower urinary tract function in women. Despite its widespread use, urodynamics (UDS) is an invasive test which can be uncomfortable for patients and incur additional cost and time [1]. A common application of UDS is to investigate refractory overactive bladder symptoms (OAB) with the aim to observe detrusor overactivity (DO). Ultrasound (US) measurement of bladder wall thickness (BWT) has been previously proposed as an alternative method for identifying DO [2, 3].
We hypothesise that US measurement of BWT is an accurate method for diagnosing DO.
Study design, materials and methods
This review was registered on PROSPERO and the PRISMA guidelines were followed throughout. A literature search was conducted of databases: “Embase”, “Medline”, “PubMed”, “Google Scholar”, and “Open Access Thesis and Dissertation”. Two independent reviewers screened abstracts for inclusion (see figure 1 and table 1). A risk of bias assessment was conducted using Robins-I V2 tool. Meta-analysis was conducted with exclusion of one study to reduce data heterogeneity. Statistical analysis was conducted using IBM SPSS Statistics.
Results
225 abstracts were screened with 9 studies being included in our final review and analysis (see figure 1 and 2). 8 studies measured BWT using a transvaginal approach and 1 used transabdominal scanning. 7 studies performed lab UDS and 2 utilised ambulatory UDS +/- video-cystourethrography for diagnosing DO. 5 studies concluded that BWT measurement can be used to diagnose DO suggesting a diagnostic threshold of approximately 5mm (4.4mm-5mm). Studies looking a 5mm BWT for diagnosis of DO reported sensitivities 43-84% and specificities 62-89%. 
Paired samples T-test was performed. The mean BWT in those “with DO” was found to be 5.234 +/- 1.424 and those “without DO” 4.356+/-1.124. Those “with DO” were found to have a mean increased BWT of 0.879 +/-0.958 (95% CI 0.143 to 1.615) when compared to those “without DO”. This was found to be a statistically significant difference t=2.754, p=0.025, d=0.958.
Meta-analysis was performed from six studies (possible from the data published) where transvaginal US measurement of BWT was used. The overall effect size was 0.196 with confidence intervals crossing the no effect value (see figure 3).
Interpretation of results
The mean difference between BWT measured in those “with DO” and those “without DO” is statistically different. However, the spread of measurements taken is broad meaning that variance and confidence intervals about this mean are large (i.e. the distribution of data is wide and flat about the mean) and effect size crosses the no effect value (see figure 3). This means that ultrasound measurement of BWT is ineffective for diagnosis of DO and this approach cannot be used to replace urodynamics.
Concluding message
There is variation in US method for measuring BWT and UDS technique used in studies included in this review. Different diagnostic thresholds have been proposed for determining DO, however, current literature does not indicate that BWT measurement can reliably identify DO.
Figure 1 PRISMA diagram of database search
Figure 2 Table of studies included in systematic review
Figure 3 Forest plot demonstrating meta-analysis of size studies
References
  1. Serati M, Braga A, Rosier PFWM, de Wachter S, Uren A, Finazzi-Agrò E. Acceptability and perceived value of urodynamics from the patient perspective: A narrative review. Neurourol Urodyn. 2022 Jun;41(5):1065-1073. doi: 10.1002/nau.24932. Epub 2022 Apr 14. PMID: 35419867; PMCID: PMC9322284.
  2. Khullar V, Salvatore S, Cardozo L, Bourne TH, Abbott D, Kelleher C. A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound. Ultrasound Obstet Gynecol. 1994 May 1;4(3):220-3. doi: 10.1046/j.1469-0705.1994.04030220.x. PMID: 12797185.
  3. Oelke M, Khullar V, Wijkstra H. Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials. World J Urol. 2013 Oct;31(5):1093-104. doi: 10.1007/s00345-013-1030-6. Epub 2013 Feb 6. PMID: 23386057
Disclosures
Funding no funding Clinical Trial No Subjects Human Ethics not Req'd This is a review and meta-analysis of previously published literature Helsinki Yes Informed Consent Yes
07/07/2025 06:52:08