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Introduction: Baseline urodynamic characterization in patients with neurogenic lower urinary tract dysfunction (NLUTD) allows detection of unsafe storage and voiding pressures and optimization of these parameters through medical or surgical intervention. Surveillance urodynamics (sUDS) studies are performed in the ambulatory setting after baseline characterization, with the goal of monitoring bladder function. How often this study should be performed and the circumstances that should prompt repeated studies are unknown. The primary objective of this review is to evaluate the evidence supporting sUDS in the setting of NLUTD as assessed by whether the study leads to 1) change in patient management; 2) determination of new findings not suggested by imaging or symptoms; and 3) demonstration of superior outcomes compared to observation. The secondary objective is to review sUDS practice patterns among urologists in their assessment of NLUTD. Methods: PubMed, EMBASE, and Cochrane Library databases were reviewed for English-language literature published between January 1975 and March 2018. Results: Twenty-eight independent articles (1368 patients, 9486 patient-years of followup) were included. Given heterogeneous data, 49% of 263 subjects were asymptomatic, yet demonstrated sUDS abnormality prompting treatment. Eight cross-sectional studies (four spinal cord injury [SCI], two NLUTD, two spina bifida) surveyed urologists regarding current sUDS patterns; 53% of 498 respondents perform sUDS between one and three years. Conclusions: Evidence supporting optimal surveillance for NLUTD is lacking. Level 2b‒4 evidence suggests that sUDS is likely to modify patient treatment and often demonstrates findings that modify treatment in the absence of symptoms or imaging changes.

Introduction: In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified.Methods: Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared.Results: Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP.Conclusions: MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.

We provide an overview of advanced imaging techniques currently being explored to gain greater understanding of the complexity of stress urinary incontinence (SUI) through better definition of structural anatomic data. Two methods of imaging and analysis are detailed for SUI with or without prolapse: 1) open magnetic resonance imaging (MRI) with or without the use of reference lines; and 2) 3D reconstruction of the pelvis using MRI. An additional innovative method of assessment includes the use of near infrared spectroscopy (NIRS), which uses non-invasive photonics in a vaginal speculum to objectively evaluate pelvic floor muscle (PFM) function as it relates to SUI pathology. Advantages and disadvantages of these techniques are described. The recent innovation of open-configuration magnetic resonance imaging (MRO) allows images to be captured in sitting and standing positions, which better simulates states that correlate with urinary leakage and can be further enhanced with 3D reconstruction. By detecting direct changes in oxygenated muscle tissue, the NIRS vaginal speculum is able to provide insight into how the oxidative capacity of the PFM influences SUI. The small number of units able to provide patient evaluation using these techniques and their cost and relative complexity are major considerations, but if such imaging can optimize diagnosis, treatment allocation, and selection for surgery enhanced imaging techniques may prove to be a worthwhile and cost-effective strategy for assessing and treating SUI.

The growing use of maternal fetal ultrasound is leading to thediscovery of an increasing number of suprarenal masses. Ourexperience with a cystic suprarenal mass detected on antenatalultrasound is described. Location and radiographic features couldnot rule out the possibility of a cystic neuroblastoma; therefore,surgical resection of the mass was performed. Despite the absenceof common radiologic characteristics, the pathology of the specimenrevealed a non-functioning upper pole of a duplex kidney withcomplete duplication of the collecting system. Neonatal evaluationand management and the differential diagnosis are discussed.

Large pelvic cysts and moderate to severe hydroureteronephrosis were found after investigating hypertension in a 16-year-old child with Marfan’s and known pelvic dural ectasia. Follow-up magnetic resonance imaging demonstrated extensive ectasia of the dural sacat the sacral level with displacement of the bowel, bladder and bilateral ureteric obstruction with accompanying hydroureteronephrosis that was advanced compared to prior imaging. Postural headaches secondary to cerebrospinal fluid leak and progressive hydroureteronephrosis prompted a combined neurosurgical andurologic resection of the pelvic masses. In this report, we discuss the preoperative evaluation and management of this rare form of bilateral ureteric obstruction.