Portable Bladder Scanners for Home Use

When I first got it I checked it quite a few times against catherized volumes when I first got it. It's not down to the ml accurate (but who knows if the one in your doctors office is) but it gives me an excellent and workable number (and picture) that shows whether the bladder and/or diverticulum is very full, moderately full, close to empty or empty. And that's really all I need for practical purposes.

Some of the variance may be the alogorithm used, some of it may be lack of definition of the bladder wall due to my irregular bladder, and some may have to do with the fact that I'm not a radiologist who might mark a more exact bladder wall eliminating variables such as bowel gas and overlapping prostate. Also, I've found, depending on fluid intake, that the bladder can start filling up in the minute or two between doing the scan and catherizing. But again, sort of nitpking here because it's accurate enough for all practical purposes.

Jim

Back to the accuracy part, another element is that my particular scanner is 2D so for greater accuracy you have to do two scans, a transverse and sagital. I rarely do the sagittal scan because the transverse is accurate enough. 

The more commonly used machines in uro offices and elsewhere are the Verathon 3D fully automatic models which just give a number an no real time picture. These have been tested in studies and found to be quite accurate HOWEVER since there is no ultrasound picture it is important that they are calibrated yearly because without a sonogram to look at you are trusting the machine completely. While, as stated, more than suffiicent for most home users, I am very disappointed to see these units in so many urologist's offices. Yes, they are somewhat "idiot proof" and are often used by nurses, PA's and lesser trained nursing home personel (not to say they are "idiots' btw) but the downside is that all you get is a number with no picture of bladder architecture or any irregularites such as a diverticulum or trabeculated bladder wall. 

I saw a well known bladder specialist and I couldn't believe this was the type of scanner his nurse used pre-exam. I still can't believe they don't have a real-time unit in their office! My first two uro's had real time units similar in function to mine. So it's a mixed bag out there when getting scanned at the uro. 

Jim

The Verathon BVI 3000 is an older model and the most readily available used online. If you're interested I have a souce that might still have reburbished units, newly calibrated for $1,800 with I believe a 30 day trial and limited warranty. Less than that you are taking a chance both in terms of the unit functioning and the calibration. Unlike my real time unit, the Verathon auto 3D units need to be properly calibrated. Verathon charges around $700 (or more) but my source will calibrate for I believe $300. That said, calibration is only one issue, the other is the unit itself and many of the cheap 3000's are being sold for "parts" meaning you don't know what you will get. I suppose if you could negotiate a return policy on the unit, you could then calibrate it yourself (with a catheter) or at least see how out of whack the calibration is. Also, not sure, but I think the 3000 requires batteries which could also be expensive. 

Jim

My unit is the Portascan Plus which goes under different distributor names including Mediwatch, Bard and now Laborie, the current distributor. There were a bunch for sale online a few months ago, including some parts, and I cobbled mine together. The only one for sale now on ebay looks in excellent shape but is selling for close to 3K which is reasonable but it's still 3K. But if you want this type of unit (real time with picture) I might be able to help a little  or at least keep an eye out for you. There is also a regular Portascan model (similar) and an even older one, but again I haven't seen anything lately.

Jim

A scanner is nice to have but is not a necessity for me right now since I am cathing daily any way. My current scanner is a catheter and a bottle and it is doing OK. I am just curious right now. Not ready to buy yet.

However, It is good of you to open this thread to help informing others. Hank

If you're on a regular 4-6x/day then no need to measure residuals with a scanner, you can do that with the catheter and a marked beaker. It make more sense if you're not on a regular cath schedule and want to monitor residuals for either a bespoke cath plan and/or bladder retraining for OAB. In my case I got it because I'm currently not self cathing and wanted a handy safety check to make sure my bladder isn't getting stretched. That and it has helped me understand the dynamics of how my bladder and diverticulum work together, something that my uro's only had guesses. FWIW my particular model also does kidney scans (and maybe some others) but I never have gone into that mode because I'm sure I'd scare myself with this shadow or that

Jim

Comparable used units would be $2000 but this doesn't have a calibration certificate with it which should not be a problem given the return policy as you can check the calibration yourself against catherized volumes and/or get it it calibrated (with certificate) yourself for another 300 or so, which probably isn't necessary unless you're using it on patients where calibration is required by law. So a good deal for self use.

Jim

Hi, my husband needs to self catheter once a day as his bladder muscles are not working. Would like to get a scanner so we know if he had voided. We are not that tech savvy, so need something not too complicated. If you know of any let me know. THanks

Hello, James, I'd like to know more about this unit. Thanks.

Hi Yani,

It was a used Mediwatch Portascan Plus on ebay. I believe it's been sold by now. Are you self cathing now? How did you plan on using the unit?

Jim

Hi Jim:

I just purchased a used Mediwatch MD-6000 (which is essentially the Laborie Portascan 3D) off of eBay.  I've been searching on the internet, but haven't found a guideline for how often a bladder scan can be conducted without safety concerns.  I know that ultrasound is generally safe and the scan period is fairly brief, but am curious if you have any information on this topic.  Thanks.

Congrads! Nice machine. That's a newer version of my Portascan Plus. Main difference is that it's a 3-D scanner as opposed to mine which is 2D. Only disadvantage, if I'm correct in this assumption, is that unlike with the Portascan Plus, the software does not allow you to manually re-draw the bladder outline. This only becomes a problem if you have an irregular shapped bladder or a diverticulum like I have. Or maybe they revised the software since I checked to allow manual re-drawing?

You can use to your heart's content, ultrasound has no radiation and is perfectly safe.

Can I asked why your purchased it? Two popular reasons are to measure PVR and/or bladder retraining with overactive bladder. Have you tested its accuracy against either your doctor's machine, or better yet against catherized voids?

If I may ask, how much did you pay?

Jim

Let me answer your last question  first.  The scanner was listed for $3400 on eBay. I liked it because it was listed as having  all of the accessories (probe, two batteries, adapter  and manuals) in addition to the  scanner.  I initially offered $1600 and we settled on $2,000.

I suffer from BPH and prostatitis a couple of times a year.  My urologist is of little help and I'm beginning to realize he is a "cutter".  The last episode of prostatitis, which yielded a high PSA,  he balked  at prescribing antibiotics preferring instead to schedule a biopsy.  I finally convinced him to prescribe antibiotics and lo and behold my symptoms subsided, my PSA dropped to acceptable levels and free PSA and PCA-3 test results were normal. I've also had three episodes of acute retention (two recently).  While I have never been catheterized nor did I seek medical help, they were painful and worrisome. 

I plan to retire soon and want to travel alot.  However, traveling with LUTS can be very problematic.  I have been keeping a voiding diary and it seems to me that I now need to know the PVR. My diary has shown that the amounts voided during  the daytime per  trip  are relatively low (around 150 ml).  I would like to increase  this amount, but need to understand more  about how my bladder is working and the various factors that affect both frequency and amount voided per trip.

My goal is to establish a "baseline" at this point in time so I have something to compare future improvement or detioration against.  Although I could get PVR measurements at the urologist, there seems to be some evidence that the  occassional bladder scan in a clinical setting provides  nothing more than a ballpark  number.  Also, in a previous life, I was an engineering researcher, so I don't mind collecting and analyzing data (although there are many more variables  with  LUTS than I'm used to).

I used the bladder scanner for the first time today.  I'm using it by myself (i.e. no assistant).  I had some problems with initial readings that were very  low (around 2 to 30 ml).  I realized that I really needed to move the  scanner head (much more than what was shown in the training video) in order to get what seem like reasonable readings. I'm guessing that from my vantage point, I'm not placing the scanner in the middle nor at the right location (with  practice I should  get better at it). It would seem to me that I could "calibrate" or check the results by taking a bladder scan just before voiding and right after voiding and in between peeing into a graduated beaker to get the amount voided.  I'll try  to do this in the next day or so (I'm still getting used to the machine).

Some literature that I've been reading seems to indicate a correlation between peak urination flowrate and LUTS symptoms.  With a stop watch I can only measure the average flowrate.  I need a flowmeter type device to measure  peak flowrate. There's only a couple listed on eBay and it's hard to get much information.  Do you have any experience with peak urination flowrates you care to share?

Excellent price for that unit. Everything you say makes sense regarding getting the unit. I'm assuming this is a real time scanner meaning you see an actual ultrasound image of the bladder as opposed to a video representation? If so, you should notice that when you move the probe the bladder size and shape will change. You want to get the reading when the bladder is the largest. There are Youtube videos that show proper scan technique and angles. They may even have a video for your specific scanner.  Don't be afraid to push firmly down and change the angle of the probe moving it back and forth to get the right angle. Also, use the ultrasound gel liberally because it's the gel medium that will get you the good pictures. I use Aquasonic 100 and bought a case on Amazon. It was the one I saw being used in my uroloigst's office. Some people do ok with a store bought water based lube like K-Y.

That said, you really want to check it's accuracy. One way is by taking it to the uro and doing back to back scans with his machine versus yours. You can accomplish the same or even better at home.

Like you say, one method is to hydrate up, do a scan, void into a measured beaker, and right away do another scan. The difference between the two scans should be close to what is in the beaker.

Better than that is to use a catheter where you can empty your bladder completely. Sounds like you've never used one but as long as you've gone this far something to consider. With a catheter, you will be able to completely empty your bladder and and get a base zero reading on your scanner. You can also hydrate up, and measure your total bladder volume. Then void and measure your PVR. Then self cath. The amount you self cath should be close to what the estimated PVR was from the scanner. Keep in mind these scanners are not 100% accurate all the time. And that includes the one in your doctor's office, but they do give you a very good general idea on volumes.

I thing a lot of people (and uros) get too hung up on flow rates. As long as you empty your bladder completely what difference does it matter if it takes you 30 or 45 seconds? Also, there are other things besides LUTS that effect flow rates such as how hydrated you are, salt intake, alcohol and coffee consumption, even your diet. For example, on a high protein/low carb diet you tend to void faster because the diet is somewhat diuretic.

That said, there are some devices on Amazon that say they measure flow rates. I'd read the reviews. A DIY method is to get a stop watch and a beaker. I'd let the stream get started for a second or two and then hit the stop watch for ten seconds. As soon as the stop watch starts aim for the beaker and aim away after ten seconds. Then divide the ml in the beaker by 10 and you have your ml/sec flow. You will not however get "peak" flow from this method, just sort of an average flow. To get peak flow you need some sort of uroflow device like the inexpensive ones on Amazon or you could invest in a pro version if you felt it important. I suppose if you are very coordinated you could try to capture only a few seconds of flow when it was peaking with the stop watch. Also, there may be some formulas for correlating peak flow to average flow you can use.

Jim

I thought the price was good too.  For these scanners, I don't think there is any reason to offer anywhere near full price.  I suspect most vendors will take a much lower price.

You are right about trying to capture just an incremental portion of the urine stream after it gets going in order to get an approximate estimate of the peak flowrate.  From the literature I've read, a number greater than 15 ml/sec is good. I'll give it a go.

Which flowmeters on Amazon are you referring to?  I've ordered something called a Uflow meter for $11.  I couldn't figure out how it works exactly from the description, but have ordered it anyway just because it is cheap.

One last thing I'll mention is that after my last acute retention episode (middle of May), I had my GP prescribe Flowmax.  I only tried one pill and then became concerned about potential side effects (my BP is  already a bit low and I'm concerned about the impact on the eyes).  However, shortly after I took that one pill, I was able to void about 240 ml, which is unheard of for me during the day.  I still have the whole  bottle and will probably try it again.  But first I want to establish my baseline parameters/statistics before I try various treatments.  Thanks.

If you go to ebay and search under "uroflow" you should get some hits starting at $150. I saw the one on Amazon as well for $11. Personally, never really looked into them and have just used stop watch from time to time. If you have already had acute urinary retention then learning how to self cath might be something to consider. Beyond checking the accuracy of your scanner it can save you a trip to the ER. Let me know if you go in that direction and I can tell you what to get and use etc. Start slow on the Flomax and maybe cut the dose in half until the body adjusts. Another alternative is daily 5mg Cialis with the bonus of enhanced sexual performance. That said, all these alpha blockers tend to have some side effects so have to experiment with them and dosages.

Jim

OK, I'll give it one more try.  Sorry, I didn't respond to your comments on the scanner.  Yes, it is the type where if you move the scanning head, the image changes. There is a video of the unit in action on the Laborie website.  Go to their website and click on the menu item labeled "Products" and then click on "Urology & Urogynecology". On the web page that comes up, scroll down and click on "Portascan 3D".  On the web page that is displayed scroll down a ways and click on the training video titled "Portascan 3D  Proper Scanning Technique".  My scanner  looks exactly like this one except for the names (unit model number and distributor).

Yes, Laborie just acquired the distribution rights recently. Previously it was Meditwatch. Before that I think GE. Bard in England had some of the identical units, at least the 2D models I have. No idea who really made the unit. The key again to get a good scan is to keep slightly rocking the probe to get the largest bladder image before taking the volume. I always use mine by myself so that isn't an issue, just need to prop up the unit in a way that will give you a good view of the sceen while you are doing the scan. I noticed in the listing that you have a 30 day return, so just make sure you do your accuracy testing within that time frame by comparing the results against known volumes as described in my previous posts. I wouldn't worry if it's not within the 10% claimed but if you keep getting say 2 to 30 ml PVRs when in actuality the PVR is 100 or more, then either: (1) wrong technique; (2) faulty unit or needs calibration; (3) incompatible bladder (diverticulum, etc).

Jim

Jim

So I received the $11 urine flowmeter that I purchased from Amazon (MDTI Uflow meter).  Their website contains information on how the unit works.  The unit has a funnel on top and three narrow chambers below it ultimately ending in an orifice.  When urine flows through the device it backs up into one of the chambers because the orifice constricts  the outflow.  While urinating, the urine level in one of the chambers will at some point remain  steady for some amount of time (depends on how much is urinated).  The instructions say that when the urine level is constant (steady), the person should note which chamber that occurs in.  If the level is constant in the lowest chamber (closest to the orifice) the peak flow rate is less than 10 ml/sec.  In the middle chamber the peak flow rate is between 10 and 15 ml/sec. In the top chamber the peak flow rate is greater than 15 ml/sec.  The instructions say to lean forward in  order to see where the level is in the device.  I've found it is easier to lean a bit to the side and look at the urine  level from the side. The instructions say that "if most of your measurements are in the top of the tube (> 15ml/sec), your urine flow is acceptable.  If most of your measurements are in the bottom or middle of the tube, you should seek advice from your doctor/nurse".

While this is a coarse instrument, it does give you a rough estimate of the peak flow rate.  Many urologists and researchers believe that measuring the  peak  flow rate is a proxy for the level of constriction  in the urinary tract.  This makes sense to me.

While the chambers do seem to only provide an approximate value, it seems to me that if the level is in the middle chamber (10 to 15 ml/sec), then where that levei is in that chamber might allow for interpolations.  For example, if the steady level of urine  is  halfway up the middle chamber, then the peak flow rate is probably halfway between 10 and 15 ml/sec.  This interpolation probably cannot be made in the top chamber (> 15 ml/sec). For the bottom chamber one would have to assume that a level right at the orifice results in a flow of 0 ml/sec in order to interpolate.  

At any rate it is a cheap, easy-to-use instrument for home use.  It might be useful for watching worsening or easing of  LUTS symptoms. 

Glad it worked out. Yes, uro's use uroflow as a proxy but PVR and IPSS score is more important. For example, I'd hate for some with low PVR and IPSS score get a procedure solely because of poor flow. My brother has slow flow but everything else is fine. The extra 20 seconds voiding hasn't impacted his life too much

Jim

Agree that low peak flow is just one "data point" to watch.  But I also suspect that low flow rate leads to higher PVR.  Do you know of any studies that suggest there is no correlation between peak flow rate and PVR?

I guess what I am saying is if peak flow data is low it probably makes sense to have a PVR measurement done, if not already available.  But I agree that if the PVR and IPSS scores are good, why have surgery done or even start medication?  An extra minute or two to "go" shouldn't really impact anyone.

I'm sure there IS a correlation but the decision making process has other considerations. PVR is easy enough to track, especially when you have a scanner at home!

Jim

Hi Jim.

What kind of variation do you usually see when taking multiple readings? I'm getting better at it, but still tend to see a range of readings (example: 163, 123, 134, 113; in this example, I threw out the high and low numbers).  Also, you said previously to look for the largest image when scanning.  Some of my images look somewhat triangular (but not  pointed at the top).  But others really have a weird elongated horizontal shape and they tend to result in the higher readings.  Any advice? Thanks.

Hi, from one of your posts above, I just bought the $11 Flow meter from Amazon. Hope you get commission for it. 😀 Hank

I've never been catheterized.  When you say "bladder sonogram" I'm not sure what you are referring to.

I just discovered that the gain on the machine is set to 30 when it should be kept at the default of 20. 

Have you then compared for example with first taking a scan on a full bladder, then voiding into a marked container, then scanning after the natural void? Then you compare the difference between the two scans to the amount in the container.

On my machine you see a real ultrasound image of the bladder. Then when I hit the "scan" buton, a broken line appears around what the machine thinks is the bladder and a number pops up which is the estimated bladder volume in ml.  Does your machine do that?

On my machine, if the broken line doesn't conform to the bladder shape I have the ability to re-draw the line conforming to the bladder shape. Then I push another button and the machine re-calculates the bladder volume based on the re-drawn area.

I have an irregular bladder so half the time the machine gets my bladder shape the first time and half the time I have to re-draw it before computing the volume.

What setting are you talking about?

Jim

Oh...I see, the "gain" setting. I believe I've left it at the default setting.

Jim

Yes it was the gain and I just set it back to the default.

If you look at the youtube video around the 2;14 mark, you will see the outline created around the blackend part of the image which is the bladder. You should check to make sure that line is being drawn accurately. On my machine you can actually adjust that line to better conform to the bladder if necessary. Your machine doesn't have that capability but it may not be necessary because of the 3d accuracy. If you want to see how my machine works in comparison, go to youtube and search for "Portascan Plus"

Jim

Hi Jim:

I'm assuming you are looking at the Laborie instructional video titled "Portascan 3D Proper Scanning Technique Instructional Video", which can be viewed on the Laborie website.  At the 2:18 mark you will see the circle with crosshair lines.  This is what I was referring to earlier as something I have not been paying attention to.  I have been looking at the earlier image where the bladder is outlined with green lines and have been attempting to get the green outlined bladder to be centered in that image.

With regards to accuracy, it's not as simple as I led you to believe.  For example, yesterday morning upon waking up I ran a series of pre and post void scans.  Here are the results:

Time: 7:35 AM  Prevoid Scan = 431 ml.  Voided amount in measuring container = 200 ml.  Post-void scan = 224 ml.

This looks really good in that 431 - 224 = 207 ml.  This is within 3.5% of the 200 ml measured in the calibrated beaker.

However I voided again 12 minutes later and look at the results now:

Time: 7:47 AM  Voided amount in measuring container = 190 ml.  Post-void scan = 150 ml.

I did not take a prevoid scan at 7:47 AM because I figured that the post void scan from 7:35 would still be reasonably accurate.  If approximately true, though, how could I have voided 190 ml with a PVR of 150 (the sum of which is 340ml), when the Post void scan from 7:35 AM resulted in only 224 ml of liquid left in the bladder?  Is it possible that the kidneys produced 116 ml of urine in 12 minutes??!

So you see these results make me wonder.  At any rate, I took a PVR scan this morning and paid particular attention to the comments I made in the first paragraph (circle with crosshairs).  It took three tries, but I seem to have gotten the largest image nicely centered and taking up most of the circle (even though the amount was only 111 ml).  My scan looks better than the one in the Laborie video at the 2:18 mark.  Also notice in that video that the two readings shown are 59 ml different.  I've seen this in some other videos using the Laborie device where a technician did real time back-to-back scans.  I like this scanner, but you really have to search for the largest image and have to run multiple  scans. It seems to be a feel issue.

Do you think it might be a good idea to get a phantom bladder?  Do you know where I can get one cheap?  

The bladder should not be "centered" in the green line, the green line should actually outline the bladder. Take a look at the videos of my machine and maybe you'll see it more clearly.

Your results seem very accurate to me. I'll take a better look later, but being off even 100ml is not a big deal. The idea is to get a general idea. Even the scanners in the doctor's offices are off sometimes more than you would imagine.

Depending on how active the kidneys are producing, it's quite possible that amount of urine was produced in 12 minutes or at least part of it. On the other hand it could just be a normal variance.

When I first cathed at my urologist's they gave me a 1000ml beaker to cath into based on a bladder scan 20 minutes earlier. I ended up voiding around 1500ml!!!!  The PA was very perplexed because she was expecting less than 1000ml based on the scan. It was either scanner error or urine production within the 20 minutes, or a combo of both.

Jim

I don't think you need a phantom bladder based on your numbers and I may be wrong but the phantom bladders may be specific to a machine and are usually costly. Calibrating it against known volumes like you are doing should be as or more accurate.

I'm beginning  to wonder if I'm scanning correctly.  I'm laying in a supine position with my head a bit elevated and have the probe angled towards my anus (as best as I can).  I get the largest readings when I push in a bit but I can also feel the probe resting against a hard thing, which I assume is the pubic bone. If I reposition the probe an inch or so closer to my head (away from the pubic bone), it is harder to get a stable image.  The reading in this latter position, though, is 60 to 80 ml or so less.  If the probe is resting against the pubic bone, then I'm wondering if it is also measuring the pubic bone and giving me a high reading.  I saw a video where the nurse said that the bladder is beneath the pubic bone, which is why the probe needs to be angled (45 to 60 degrees).  There are also scanners that warn you that the scan might be including the pubic bone.  So now I'm confused.

With regards to the green lines, I really can't see the bladder easily in these real time images (with green lines).    All of the scans in the video show the  vertical green line pretty much splitting the green outline down the middle.  They also say that the bladder silhouette should appear in the center of the cross hairs (I don't think they are talking about the image with the green lines, but after the image has been taken where there is a circle with crosshairs and a bladder silhouette in white).    I think that the green lines are part of the pre-scan phase that helps you find the bladder.

Finally, with regards to accuracy, my research suggests that being off 100 ml is a big deal.  A PVR of around 50 ml would be great at my age and with the BPH.  However, I read that PVR values greater than 100 ml are a guideline at which potential action should be considered and that a PVR of 150 ml or higher indicates urinary retention.  Do you agree with these guidelines?  Thanks.

Looking for advice from anyone who will answer.  I'm having considerable difficulty getting consistent bladder scan results.  For example, I just took five scans after voiding and they were 85, 174, 173, 163, 130.  Both the post-scan image of the 85 ml and 174 ml were in the center of the cross hairs and looked pretty circular.  I took a pre-void scan and it resulted in a nice post-scan image that was dead center in the crosshairs of 240.  The measured void amount was 150ml, so the 85 ml result would seem to make sense (assuming the 240 ml result was correct.

Should I always take the largest amount as the correct amount, esp. if the after scan image shows that it is well centered in the crosshairs?

Hi. As I menioned before you will find your answers by comparing scanned results with actual voided volumes. except for the 85 your results are very consistent. Also, it's not just the cross hairs, that's just for aiming,  but you want to make sure that the outline drawn by the machine actually conforms to the actual bladder shape. If it doesn't then your reading will not be accurate.

Jim

It works well for such a simple device. You'd have to bend over to see the level, and it's not constant. So I try not to blink. Thanks. Hank

Hi Jim:  To my understanding this particular scanner doesn't work that way.  During the pre-scan there is a bladder image, which is very hard to see.  To help discern it, it is surrounded by a green outline and there is also a green vertical line contained within this green outline (this is not the cross hair I've mentioned). You're supposed to subtly move the scanner around until this green vertical line is in the center of the green outline of the bladder (bisecting this green outline).  Then you let go of the button and the scan finishes up.  After the scan is over an image is shown of a circle with cross hairs.  Within this circle there is a white blob  that represents the bladder.  This white blob is supposed to be centered in the cross hairs of the circle.   My issue is that I got this post-scan white blob centered in the cross hairs at both 85 and 174 ml.  

After I posted, I think I figured out somewhat what was going on. The pre-void residual of 240 ml was taken about ten minutes before.  I figured it would still be fairly representative.  But I was also testing the effect of a diuretic (two 300 ml cups of peppermint tea).  Within the space of 80 minutes I urinated six times with five at 150 ml and one at 120 ml (typically urinating every 15 minutes or less).  So the 240 ml was most likely not very representative.  We had this discussion before, but I was surprised at how  fast urine is added to the bladder even though peppermint tea  has always made me pee  a lot.

I looked at the training video again today.  I think I need to be more careful on the pre-scan green outlines.  I need to look for a good outline as well as the green vertical line being centered. Today, I noticed I was getting some pretty weird looking green outlines - one actually had an arm sticking out to the right that was quite long (never saw that before).  Thanks for the reply.

Hank:  I agree.  I think it's useful in looking for changes over time.  I'm trying to baseline and record my current LUTS with bladder scans and peak flowrate.  That way I can see how things change 1 year, 3 years, 5 years..... down the road.  To me it's better than saying to myself - "I'm pretty sure things have gotten worse, but not having any quantitative data to define how much worse (or with any luck better) is. I probably need to get a scan to calculate the size of the prostate.  My uro estimates 40 cubic centimeters based on a DRE.  He's probably close, but he had the same number 15 months ago as well.  With scans I can hopefully see if it is changing over time.

I will have to look at the video again, but i think we are talking about the same thing with the green outline. Is that the ultrasound picture of the actual bladder? If so then the green outline has to conform to the actual bladder and if not you will not get an accurate measurment. In other words the machine is only going to measure what is inside the green line. With my 2D scanner I can adjust the bladder outline in cases for example where "an arm (is) sticking out". Did you see the video of the Portascan Plus? Is the pre-scan picture you're getting similar to the picture depicted in the Portascan Plus video? If so, that is a real time image of the bladder and again the green line should conform to it or your measurement will not be accurate. The reason I got the older Portascan Plus is because it allloww me to manually adjust the bladder outline if the machine doesn't draw it correctly. You can see that in the video as well. I didn't follow your peppermint tea example but you want to take a PVR with the scanner as soon as possible after your void, so ideally right away. If you wait say 20 minutes the kidneys could produce a lot of urine so you would be getting an inflated PVR with the scanner.

Jim

Jim

OK. I looked at the video again. So we're on the same page the one I looked at was on Youtube and called Portascan™ 3D Proper Scanning Technique Instructional Video" The voice ttrack sounded like a female robotic voice. Look at the 2;42 mark where it says "calculating". The dark (black) portion inside the green line is the bladder where the black is fluid. This green line should conform to the black shape (bladder) If it doesn't then the bladder volume will be incorrect because all the machine is doing is measuring volume within the green line. The cross hairs is simply an aiming device but again, what is inside the green outline is what will be measured regardless of what the cross hairs say. I think if you look at the video of my scanner as menioned earlier you will more clearly see how the measurement process actually works.

Jim

Jim

More and more I'm becoming disillusioned with the bladder  scanner.  The accuracy seems to be extremely dependent on the angle (Laborie says 45 degrees, which I'm trying to maintain as best I can), but especially on the amount of pressure.  I took a number of readings using varying pressure of the probe against my abdomen.  The more pressure, the higher the number (194), less pressure, the lower the number (85).  For me an accuracy to within 100 ml, just doesn't cut it.  Guidelines suggest one should begin to be concerned when the PVR is over 100 ml - so how is an accuracy to within 100 ml useful.  

Jim:  Before I return my bladder scanner (if they'll let me), I would appreciate it very much if you could check the readings you get with your scanner based on how much pressure you apply to the scanner head against your abdominal wall.

Thanks.

Hi, Sorry you're not happy with the scanner. I think a lot depends both on technique and what you want to get out of it. With the example you gave, you want to go with the most pressure or the higher number. Think about how the urologist pushes quite firmly against the bladder. That's what you want to do. As to accuracy, not sure if it needs to be accurate within 100ml at all levels. I use my scanner to get a general idea how I'm doing. An empty bladder looks empty on my scanner. A very full bladder looks very full. And it's also easy to discern what I would term an acceptable PVR -- say under 300ml from an unacceptable one . That's all I really wanted. If you think your urologists scanner is any more accurate you are mistaken.

That said, if you're unhappy try and return it. Ebay and perhaps PayPal protection will be behind you regardless of what the return policy say. You might then want to look at my scanner, the Portascan Plus. Not as sophisticated as yours but I like the simplicity, the larger imaging, and the ability to redrawn the bladder line when the machine misses it. Your scanner can't do that. You should be able to get a Portascan Plus for around $100 with some hunting and I will be glad to give you some tips on putting a system together if you don't find everything from the same vendor. I bought my scanner to give me peace of mind and it has.

Jim

Sorry, meant to say "$1000" not "$100"

"If you think your urologists scanner is any more accurate you are mistaken."  Yes, I've been having this nagging feeling that that's the case.

It turns out that you can redraw the bladder line on my machine.  In fact, you can do it for all twelve scans that are taken. Part of the problem I'm having is that the documentation is really poor and written in Chinese english.  I looked very closely at a few scans and it looked like the bladder outline is drawn by the machine okay.

I really want the bladder scanner to help me establish a baseline.  So if my PVR is around 100 to 150 now, what will it be in five years?  If it's consistently over 200, then I might seriously want to consider a procedure.  But if I can't establish that number now.....

I think I just need to be consistent with the way I take the readings. Instead of taking so many readings, I need to try and establish higher quality readings (more quality, less quantity).   Also, I suspect that I'm not being clinical and unbiased enough about these  measurements. I guess I don't like the fact that my PVR might really be between 150 and 200 and not 100 to 150.  Stupid, I know.

Anyway, as always, thanks for responding.

Are you sure you can redraw the bladder outline? When I called tech support a couple of years ago they told me that with this model you couldn't although they might have been mistaken. However, I didn't see any redrawing capability in the instructional video and you think they would put it there. If you look at the video of my scanner, they clearly show how the redraw function works. I think you can safely wait until your PVR is at least 300 before considering a procedure. Your machine should alert you to that. The only way to get more exact is to self cath.

Jim

I'm no expert, but I'm quite sure.  It's not shown in the instructional  video, but they talk about it in the manual that came with my unit.

From the manual "Because of the complexity of patients and high accuracy requirement, MD-6000 provides the Manual Adjustment Mode".  

After the scan is taken you touch the ultrasound image which brings up what they call this manual adjustment mode.  The image is now twice as large.  You press a button labeled "Mark".  The manual says the following regarding the "Mark" button:  "Start manual adjustment and the bladder borders can be changed". Then you just tap on the screen where you want the corners to be. As you tap the screen, red lines from one tap to the next appear.  Click on the "Mark" button again and the software will finish the last line.  The software also recalculates the volume according to the adjusted borders.

I've only played with it a bit. My first impressions are that it won't help with the issues I've raised, but it's possible.

That's what my machine does so the tech I spoke to was misinformed which is par for the course these days. No one knows much about anything even if they're selling it! Apparently that isn't your issue but nice to know you have that feature.

Jim

Haven't run any scans for about 6 weeks,  Just started up again and I'm still struggling.

I have noticed  that when I place the probe on my abdomen and then angle it at a 45 degree angle towards my anus, I tend to have the probe head push into my pubic bone.  I'm thinking this is incorrect and the probe needs to be 2 fingers width above the pubic bone.  When I place it above the pubic bone I tend to get readings that are roughly 50 mL less than when the probe head is pushing at the 45 degree angle into my pubic bone.  But the bladder images don't look all that good to me.  I've turned up the gain to try and get better contrast between what is the bladder and what is not.

Any advice is appreciated.

Hi, I thought you machine didn't give real time ultrasonic images but rather symbols for positioning. Can you PM me a link to the video again. In any event, 50ml isn't much of a difference one way or another on any of these machines. I would go with the larger reading.

Jim

Hi Jim:

The scanner does give real time images; 12 per scan.  I've started reviewing the 12 images of each scan, I take, which is typically 5 scans per session.  This seems to have helped me get better accuracy.  But when the PVR is around 50 to 120, I can get scan values of 50 and 120 in a 5 reading set and it can be tough to determine which are likely more accurate.

I have a question:  Is it possible that the bladder scanner might be showing an image of my enlarged prostate as well as my bladder?

The bladder will be the dark areas because it is filled with fluid. The prostate lighter. You can "google" both bladder and prostate ultrasound images for a more visual reference. But yes, you should see both on the ultrasound, at least I do, with the prostate protruding into my bladder as expected. That said, the scanner will just measure the bladder (fluid) area. If you're saying your scanned volumes are between 50 and 120, I don't see a 70ml variance is very much. What is your actual PVR (measured by CIC) when you get such a scan? If the actual PVR is closer to the 120 then I'd go with the larger number moving forward. In other words, use your actual PVR via CIC to calibrate the scanner.

Jim

I don't do CIC and don't have plans to anytime soon.  How does the scanner know not to include the prostate in the measurement?  When I look at some scans, I can see green lines (drawn by the scanner for measurement purposes jutting downwards or sometimes out to the side).  On some scans I can see what looks like a light gray line of demarkation between two different masses (one being the bladder and one the prostate?).  The next time I get that kind of photo, I'll take a digital camera picture and send it to you via PM, if you don't mind.  Appreciate the advice and help.  Thanks.