Classification and Diagnosis of Bladder Trabeculation

Diagnostic Evaluation

• The American College of Radiology recommends cistography with voiding as the standard method for visualizing and grading bladder trabeculation, allowing evaluation of the depth and extension of trabeculae during filling and voiding, and demonstrating indirect findings of voiding dysfunction such as trabeculated bladder, significant post-void residual, and urethral narrowing 1
• Cystoscopy complements fluoroscopic classification, permitting direct visualization of muscle bundle formation, with moderate correlation with fluoroscopic grades, and excellent inter-observer reliability (intra-class correlation coefficient of 0.986) 1

Clinical Implications

• The presence of severe bladder trabeculation predicts an element of intrinsic outlet resistance in patients with neurogenic bladder, and may obviate the need for additional outlet procedures during augmentation cystoplasty in incontinent patients 1
• Severe trabeculation is associated with hydronephrosis (57%) and vesicoureteral reflux (70%) in patients with neurogenic bladder 1

Limitations of Diagnostic Evaluation

• Bladder trabeculation is not a specific diagnostic finding by itself, and correlation with urodynamic studies is required for complete evaluation 2