Issue
Date Log
Copyright (c) 2026 Faizah Alanazi, Adbdulelah Awadh Almutairi, Dr. Mohammed Moauad, Shadi Ghali Alharbi, Dr. Kamal Alshamiri
This work is licensed under a Creative Commons Attribution 4.0 International License.
Optimizing Ultrasound Gain Settings for Enhanced Detection of Bladder Debris in Pediatric Cystitis at KSMC, Riyadh.
Corresponding Author(s) : Faizah Alanazi
Saudi Journal of Medicine and Public Health,
Vol. 3 No. 1 (2026)
Abstract
Background and Introduction: Cystitis is a common pediatric condition often caused by bacterial infection. Early diagnosis is essential to prevent long-term complications such as renal scarring and recurrent infections. A key ultrasound finding in cystitis is the presence of bladder debris, which indicates inflammation or infection. Despite the widespread use of ultrasound for pediatric urinary tract evaluation, variability in gain settings significantly affects the visibility of bladder debris. Currently, there is no standardized guideline on optimal gain settings for this purpose. King Saud Medical City (KSMC), Riyadh, aims to address this diagnostic gap through targeted optimization of ultrasound imaging protocols.
Aim: To optimize ultrasound, gain settings to improve the detection and diagnostic accuracy of bladder debris in pediatric cystitis cases at KSMC.
Methods: This retrospective observational study will include 70 pediatric patients (aged 2 months to 12 years) underwent bladder ultrasound as part of routine evaluation. Each patient had five transverse bladder images captured using incremental gain settings (40%, 50%, 60%, 70%, 80%) on GE LOGIQ E9 and LOGIQ ultrasound machines. A curvilinear probe (2–9 MHz or 1–6 MHz) used based on patient age. Two radiologists independently assessed the clarity and presence of bladder debris using a standardized scoring system then by two technologists. Findings will be compared to clinical data, including urinalysis (leukocyte esterase, nitrites, pyuria) and urine culture, to evaluate diagnostic sensitivity and specificity at each gain level.
Results: This study anticipates that moderate ultrasound gain settings, specifically between 60% and 70%, will significantly improve the clarity and visibility of bladder debris, thereby enhancing diagnostic accuracy compared to lower or higher settings. This optimized range is expected to show a stronger correlation with clinical findings and decrease the likelihood of under-detection or misdiagnosis.
Conclusion: The optimization of ultrasound gain settings holds the potential to elevate the diagnostic accuracy for pediatric cystitis by improving the visualization of bladder debris. The study's outcomes are intended to support the development of standardized gain protocols, contributing to evidence-based advancements in pediatric imaging practices at our institution and potentially influencing practices elsewhere. This way of working may also decrease unnecessary procedures and enhance overall patient care.
Keywords
Download Citation
Endnote/Zotero/Mendeley (RIS)BibTeX
- Sujith, S., Solomon, A. P., & Rayappan, J. B. B. (2024). Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Frontiers in Cellular and Infection Microbiology, 14, 1402941.
- He, Y., Zhao, J., Wang, L., Han, C., Yan, R., Zhu, P., ... & He, W. (2025). Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021. Scientific Reports, 15(1), 4702.
- Wilson, M., & Wilson, P. J. (2021). Cystitis. In Close Encounters of the Microbial Kind: Everything You Need to Know About Common Infections (pp. 347-360). Cham: Springer International Publishing.
- Wagenlehner, F. M., & Naber, K. G. (2006). Treatment of bacterial urinary tract infections: presence and future. European urology, 49(2), 235-244.
- García-García, J. D., Contreras-Alvarado, L. M., Cruz-Córdova, A., Hernández-Castro, R., Flores-Encarnacion, M., Rivera-Gutiérrez, S., Arellano-Galindo, J., A Ochoa, S., & Xicohtencatl-Cortes, J. (2025). Pathogenesis and Immunomodulation of Urinary Tract Infections Caused by Uropathogenic Escherichia coli. Microorganisms, 13(4), 745. https://doi.org/10.3390/microorganisms13040745
- Lala, V., Leslie, S. W., & Minter, D. A. (2023). Acute cystitis. In StatPearls [Internet]. StatPearls Publishing.
- Sujith S, Solomon AP and Rayappan JBB (2024) Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Front. Cell. Infect. Microbiol. 14:1402941. doi: 10.3389/fcimb.2024.1402941
- Ibrahim, A. I. A., Abdelgyoum, H. A., Elfaki, N. S., Elbadawi, M. H., & Kashif, E. (2025). Bacterial etiology of urinary tract infections and their sensitivity patterns towards commonly used antibiotics in port Sudan City, Sudan: a retrospective study. BMC infectious diseases, 25(1), 1017. https://doi.org/10.1186/s12879-025-11437-w
- Bwanali, A. N., Lubanga, A. F., Kondowe, S., Nzima, E., Mwale, A., Kamanga, W., Enerico, C., Masautso, C., Kapatsa, T., Mudenda, S., Mpinganjira, S., Mwale, G., Chitule, C., Kawerama, A., Chibwe, I., Nyirenda, T., & Mitambo, C. (2025). Trends and patterns of antimicrobial resistance among common pathogens isolated from adult bloodstream and urinary tract infections in public health facilities in Malawi, 2020-2024. BMC infectious diseases, 25(1), 946. https://doi.org/10.1186/s12879-025-11335-1
- Nelson, Z., Aslan, A. T., Beahm, N. P., Blyth, M., Cappiello, M., Casaus, D., ... & Lora, A. J. M. (2024). Guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults: a WikiGuidelines Group consensus statement. JAMA network open, 7(11), e2444495-e2444495.
- McQuaid, J. W., Kurtz, M. P., Logvinenko, T., & Nelson, C. P. (2017). Bladder debris on renal and bladder ultrasound: A significant predictor of positive urine culture. Journal of pediatric urology, 13(4), 385.e1–385.e5. https://doi.org/10.1016/j.jpurol.2017.04.020
- You SK, Lee JM, Lee J-E, Shin KS, Lee SM, Cho H-H. (2021). Significance of sonographically detected bladder debris in children less than 2 years old with febrile urinary tract infection. J Clin Ultrasound. 2021; 49: 189–193. https://doi.org/10.1002/jcu.22964
- You, S. K., Lee, J. M., Lee, J. E., Shin, K. S., Lee, S. M., & Cho, H. H. (2021). Significance of sonographically detected bladder debris in children less than 2 years old with febrile urinary tract infection. Journal of Clinical Ultrasound, 49(3), 189-193.
- Oglat, A. A., Alshipli, M., Sayah, M. A., & Ahmad, M. S. (2020). Artifacts in diagnostic ultrasonography.
- Jequier, S., & Rousseau, O. (1987). Sonographic measurements of the normal bladder wall in children. American Journal of Roentgenology, 149(3), 563-566.
- Jones, N. M., Casto, E. S., Burkett, L. S., Speich, J. E., Roldán-Alzate, A., & Klausner, A. P. (2025). New Imaging Techniques on the Horizon to Study Overactive and Neurogenic Bladder. Current bladder dysfunction reports, 20(1), 6. https://doi.org/10.1007/s11884-025-00775-9
- Wu, S. Y., Jhang, J. F., Jiang, Y. H., & Kuo, H. C. (2016). Increased bladder wall thickness is associated with severe symptoms and reduced bladder capacity in patients with bladder pain syndrome. Urological Science, 27(4), 263-268.
- Santarelli, V., Rosati, D., Canale, V., Salciccia, S., Di Lascio, G., Bevilacqua, G., Tufano, A., Sciarra, A., Cantisani, V., Franco, G., Moriconi, M., & Di Pierro, G. B. (2024). The Current Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis and Staging of Bladder Cancer: A Review of the Available Literature. Life (Basel, Switzerland), 14(7), 857. https://doi.org/10.3390/life14070857
- Jones, N. M., Casto, E. S., Burkett, L. S., Speich, J. E., Roldán-Alzate, A., & Klausner, A. P. (2025). New Imaging Techniques on the Horizon to Study Overactive and Neurogenic Bladder. Current bladder dysfunction reports, 20(1), 6. https://doi.org/10.1007/s11884-025-00775-9
- Toymus, A. T., Yener, U. C., Bardakci, E., Temel, Ö. D., Koseoglu, E., Akcoren, D., Eminoglu, B., Ali, M., Kilic, R., Tarcan, T., & Beker, L. (2024). An integrated and flexible ultrasonic device for continuous bladder volume monitoring. Nature communications, 15(1), 7216. https://doi.org/10.1038/s41467-024-50397-8
- Oglat, A. A., Alshipli, M., Sayah, M. A., & Ahmad, M. S. (2020). Artifacts in diagnostic ultrasonography.
- Kamal, E., Elzaki, M., Alhadi, S., Zidan, M. M., & Elgyoum, A. M. (2025). Dynamic Evaluation of Urinary Bladder Wall Thickening in Sudanese Patients with Recurrent Urinary Tract Infections Using Ultrasonography: A Comparative Analysis before and after Voiding. Sch J App Med Sci, 7, 1399-1404.
- Song, Z., Asiedu, M., Wang, S., Li, Q., Ozturk, A., Mittal, V., ... & Kumar, V. (2023). Memory-efficient low-compute segmentation algorithms for bladder-monitoring smart ultrasound devices. Scientific Reports, 13(1), 16450.
- Williams D, Tan M. Ultrasound in pediatric urology: Advances and challenges. Pediatr Urol. 2018;33(2):112–8.
- Miller A, Rodriguez L, Chen Y. Cystitis in children: Diagnostic approaches and imaging modalities. Pediatr Nephrol. 2021;36(1):67–75.
- Ahmed T, Salim S. Advances in pediatric bladder imaging with ultrasonography: A clinical perspective. J Clin Imaging Sci. 2023;13(2):104–10.
- Ajiki, J., Naitoh, Y., Kanazawa, M. et al. Assessment of lower urinary tract function in pediatrics using ultrasonography. J Med Ultrasonics (2023). https://doi.org/10.1007/s10396-023-01358-z
References
Sujith, S., Solomon, A. P., & Rayappan, J. B. B. (2024). Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Frontiers in Cellular and Infection Microbiology, 14, 1402941.
He, Y., Zhao, J., Wang, L., Han, C., Yan, R., Zhu, P., ... & He, W. (2025). Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021. Scientific Reports, 15(1), 4702.
Wilson, M., & Wilson, P. J. (2021). Cystitis. In Close Encounters of the Microbial Kind: Everything You Need to Know About Common Infections (pp. 347-360). Cham: Springer International Publishing.
Wagenlehner, F. M., & Naber, K. G. (2006). Treatment of bacterial urinary tract infections: presence and future. European urology, 49(2), 235-244.
García-García, J. D., Contreras-Alvarado, L. M., Cruz-Córdova, A., Hernández-Castro, R., Flores-Encarnacion, M., Rivera-Gutiérrez, S., Arellano-Galindo, J., A Ochoa, S., & Xicohtencatl-Cortes, J. (2025). Pathogenesis and Immunomodulation of Urinary Tract Infections Caused by Uropathogenic Escherichia coli. Microorganisms, 13(4), 745. https://doi.org/10.3390/microorganisms13040745
Lala, V., Leslie, S. W., & Minter, D. A. (2023). Acute cystitis. In StatPearls [Internet]. StatPearls Publishing.
Sujith S, Solomon AP and Rayappan JBB (2024) Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management. Front. Cell. Infect. Microbiol. 14:1402941. doi: 10.3389/fcimb.2024.1402941
Ibrahim, A. I. A., Abdelgyoum, H. A., Elfaki, N. S., Elbadawi, M. H., & Kashif, E. (2025). Bacterial etiology of urinary tract infections and their sensitivity patterns towards commonly used antibiotics in port Sudan City, Sudan: a retrospective study. BMC infectious diseases, 25(1), 1017. https://doi.org/10.1186/s12879-025-11437-w
Bwanali, A. N., Lubanga, A. F., Kondowe, S., Nzima, E., Mwale, A., Kamanga, W., Enerico, C., Masautso, C., Kapatsa, T., Mudenda, S., Mpinganjira, S., Mwale, G., Chitule, C., Kawerama, A., Chibwe, I., Nyirenda, T., & Mitambo, C. (2025). Trends and patterns of antimicrobial resistance among common pathogens isolated from adult bloodstream and urinary tract infections in public health facilities in Malawi, 2020-2024. BMC infectious diseases, 25(1), 946. https://doi.org/10.1186/s12879-025-11335-1
Nelson, Z., Aslan, A. T., Beahm, N. P., Blyth, M., Cappiello, M., Casaus, D., ... & Lora, A. J. M. (2024). Guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults: a WikiGuidelines Group consensus statement. JAMA network open, 7(11), e2444495-e2444495.
McQuaid, J. W., Kurtz, M. P., Logvinenko, T., & Nelson, C. P. (2017). Bladder debris on renal and bladder ultrasound: A significant predictor of positive urine culture. Journal of pediatric urology, 13(4), 385.e1–385.e5. https://doi.org/10.1016/j.jpurol.2017.04.020
You SK, Lee JM, Lee J-E, Shin KS, Lee SM, Cho H-H. (2021). Significance of sonographically detected bladder debris in children less than 2 years old with febrile urinary tract infection. J Clin Ultrasound. 2021; 49: 189–193. https://doi.org/10.1002/jcu.22964
You, S. K., Lee, J. M., Lee, J. E., Shin, K. S., Lee, S. M., & Cho, H. H. (2021). Significance of sonographically detected bladder debris in children less than 2 years old with febrile urinary tract infection. Journal of Clinical Ultrasound, 49(3), 189-193.
Oglat, A. A., Alshipli, M., Sayah, M. A., & Ahmad, M. S. (2020). Artifacts in diagnostic ultrasonography.
Jequier, S., & Rousseau, O. (1987). Sonographic measurements of the normal bladder wall in children. American Journal of Roentgenology, 149(3), 563-566.
Jones, N. M., Casto, E. S., Burkett, L. S., Speich, J. E., Roldán-Alzate, A., & Klausner, A. P. (2025). New Imaging Techniques on the Horizon to Study Overactive and Neurogenic Bladder. Current bladder dysfunction reports, 20(1), 6. https://doi.org/10.1007/s11884-025-00775-9
Wu, S. Y., Jhang, J. F., Jiang, Y. H., & Kuo, H. C. (2016). Increased bladder wall thickness is associated with severe symptoms and reduced bladder capacity in patients with bladder pain syndrome. Urological Science, 27(4), 263-268.
Santarelli, V., Rosati, D., Canale, V., Salciccia, S., Di Lascio, G., Bevilacqua, G., Tufano, A., Sciarra, A., Cantisani, V., Franco, G., Moriconi, M., & Di Pierro, G. B. (2024). The Current Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis and Staging of Bladder Cancer: A Review of the Available Literature. Life (Basel, Switzerland), 14(7), 857. https://doi.org/10.3390/life14070857
Jones, N. M., Casto, E. S., Burkett, L. S., Speich, J. E., Roldán-Alzate, A., & Klausner, A. P. (2025). New Imaging Techniques on the Horizon to Study Overactive and Neurogenic Bladder. Current bladder dysfunction reports, 20(1), 6. https://doi.org/10.1007/s11884-025-00775-9
Toymus, A. T., Yener, U. C., Bardakci, E., Temel, Ö. D., Koseoglu, E., Akcoren, D., Eminoglu, B., Ali, M., Kilic, R., Tarcan, T., & Beker, L. (2024). An integrated and flexible ultrasonic device for continuous bladder volume monitoring. Nature communications, 15(1), 7216. https://doi.org/10.1038/s41467-024-50397-8
Oglat, A. A., Alshipli, M., Sayah, M. A., & Ahmad, M. S. (2020). Artifacts in diagnostic ultrasonography.
Kamal, E., Elzaki, M., Alhadi, S., Zidan, M. M., & Elgyoum, A. M. (2025). Dynamic Evaluation of Urinary Bladder Wall Thickening in Sudanese Patients with Recurrent Urinary Tract Infections Using Ultrasonography: A Comparative Analysis before and after Voiding. Sch J App Med Sci, 7, 1399-1404.
Song, Z., Asiedu, M., Wang, S., Li, Q., Ozturk, A., Mittal, V., ... & Kumar, V. (2023). Memory-efficient low-compute segmentation algorithms for bladder-monitoring smart ultrasound devices. Scientific Reports, 13(1), 16450.
Williams D, Tan M. Ultrasound in pediatric urology: Advances and challenges. Pediatr Urol. 2018;33(2):112–8.
Miller A, Rodriguez L, Chen Y. Cystitis in children: Diagnostic approaches and imaging modalities. Pediatr Nephrol. 2021;36(1):67–75.
Ahmed T, Salim S. Advances in pediatric bladder imaging with ultrasonography: A clinical perspective. J Clin Imaging Sci. 2023;13(2):104–10.
Ajiki, J., Naitoh, Y., Kanazawa, M. et al. Assessment of lower urinary tract function in pediatrics using ultrasonography. J Med Ultrasonics (2023). https://doi.org/10.1007/s10396-023-01358-z