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JYI.org :: A Novel, Non-Invasive Approa…

**The Journal of Young Investigators: An Undergraduate, PeerReviewed Science Journal
**

Volume 21, Issue 5. May 2011

**A Novel, Non-Invasive Approach to Diagnosing Urinary Tract Obstruction Using CFD
**

Volume 18, Issue 6 on 28 May 2008 Nirmish Singla University of Michigan, Ann Arbor

ABSTRACT

Urinary tract obstruction is a common clinical problem involving the narrowing of the ureters or urethra. Current diagnostic methods are invasive and costly, and urologists are constantly seeking new, inexpensive, non-invasive measures to diagnose obstruction. The present study investigates diagnostic applications of computational fluid dynamics (CFD) to urinary tract obstruction for the first time. Various hypothetical models were initially created in Gambit 2.1.6, in which the physics of flow was evaluated based on varying geometries and conditions. These models presented short segments of the tract and possible effects of obstruction. Flow analysis was conducted in Fluent 6.1.22 by comparing contours of velocity, static pressure, dynamic pressure, total pressure, and wall shear stress to results predicted by flow theory. Realistic models of both healthy and obstructed urethras and ureters were then similarly created and simulated. CFD equations

www.jyi.org/research/re.php?id=1518 1/29

5/18/2011

JYI.org :: A Novel, Non-Invasive Approa…

accurately predicted the expected flow characteristics through both hypothetical and realistic models. Comparison of the calculated urethral outlet velocity in the models, between 6.91 and 16.9 m/s at the urethral orifice, to human uroflowmetry data shows that the simulated conditions fall within the range of realistic human flow. The accuracy of the models suggests future clinical potential of using CFD with current techniques in human tract analysis, secondary flow effects, disease prevention, and non-invasive diagnosis.

INTRODUCTION

Urinary tract obstruction is a common problem causing urinary stasis as a result of urethral or ureteral constriction anywhere along the urinary tract. Frequent causes of obstruction include benign prostatic hyperplasia (BPH), prostate cancer, stones, urethral strictures, bacterial infections, and surgical trauma (Resnick and Sutherland 2004). In females, although less common, obstruction may arise from pregnancy complications, stones, or pelvic malignancies; urinary obstruction in children is often a direct result of congenital anomalies (Resnick and Sutherland 2004).

Table 6. Measured inlet and outlet velocities in two-dimensional cross sectional models of both healthy and obstructed cases of the urethra, simulated in turbulent standard kepsilon solver (Fluent). Specified locations of obstruction were at the bladder neck, prostatic urethra (benign prostatic hyperplasia, BPH), and spongy urethra. An inlet value of 5.0 m/s enabled convergence in the healthy model. An inlet velocity of 1.166 m/s converged only in the case of bulbar spongy urethral constriction. With the exception of the case of bladder neck constriction, the data indicates relatively higher outlet flow velocities (as compared in magnitude to the specified

www.jyi.org/research/re.php?id=1518 2/29

org/research/re. diagnosis of obstruction can be performed by lab studies including urodynamic studies. the outlet velocity was measured to be zero because of the converging effects of wall shear stress generated from the two sides of the tract. due to the severity of constriction. computed tomography (CT) scans. such as ultrasonography. Specific locations of obstruction were at the ureteropelvic junction. Peled and Yeshurun 2001. such as cystoscopy. are invasive and may cause further complications (Resnick and Sutherland 2004). Inlet velocity of 0. simulated in turbulent standard k-epsilon solver (Fluent). abdomino-pelvic junction. are costly and time consuming (Resnick and Sutherland 2004). 1997. and the available results are limited to resolutions on the order of 1 mm due to issues of hardware. Imaging studies.98 m/s and 4.5/18/2011 JYI. Urodynamic studies and endoscopic procedures. A numerical approach utilizing computational fluid dynamics (CFD) may eliminate such inconveniences.org :: A Novel. Non-Invasive Approa… inlet values).php?id=1518 3/29 . and ureterovesical junction. Table 5. or surgical procedures. and magnetic resonance imaging (MRI).26 m/s. (Click image for larger version) Currently. Data indicates decreased ureteral outflow as a result of disease. imaging studies.284 m/s converged in all cases. Prior to complete flow obstruction.jyi. especially notable in the cases of UPJ and UVJ constriction. Measured inlet and outlet velocities in two-dimensional cross sectional models of both healthy and obstructed cases of the ureter. the flow displayed a velocity range between ~2. Elad and Hel-Or 2001). (Click image for larger version) www. *Note that in the case of UVJ constriction. signal-to-noise ratio and acquisition time (Kim et al.

Such studies commonly involve the use of CFD software packages such as FLUENT. POLYFLOW. static pressure. or G/Turbo to create the models themselves. 2004). The quantitative effect of variable constriction severity on flow characteristics for the two-dimensional symmetric Venturi cross-section. Blackburn and Sherwin 2005. the magnitudes of pressure. and mechanics of arterial diseases (RuDusky 2003). CFD has also been applied to the respiratory system with regard to flow simulation and analysis (Luo et al. dynamic pressure. Jung et al.org :: A Novel. 1998. Jou and Berger 2000). and total pressure (in Pa) at the inlet. CFD modeling has been applied to the circulatory system in numerous ways involving flow effects of aneurysms. Higher inlet velocities were specified in the turbulent solver to accommodate larger Reynolds values. outlet. The trend indicates an overall direct correlation between velocity.org/research/re. and constriction www. rather than a single value.000) cases (Fluent). more accurately depicted the transverse variability in certain variables. a range of values. and site of constriction are shown for both the laminar (Re=700) and turbulent standard k-epsilon (Re=5. blood flow through stenoses (Siouffi et al. Note that in some cases. 2004. 2004). along with compatible meshing software such as GAMBIT. 3 mm wide). analysis of heart valves (Lim et al. Numeric data for velocity (in m/s).5 mm deep. or FIDAP to perform model simulations and numerical analysis.jyi. mild and severe cases were analyzed. Non-Invasive Approa… Much research in the field of mechanical engineering is concerned with flow through constricted tubes and its application to various organ systems. Compared to the control case of moderate constriction severity (1. 1980).php?id=1518 4/29 . Fluid mechanics within the gastrointestinal tract have even been evaluated (Ooi et al. Table 4. TGRID.5/18/2011 JYI.

5/18/2011 g JYI.php?id=1518 5/29 . with emphasis on the effects of urinary tract obstruction.22 was used to simulate the flow mechanics inside the urinary tract.jyi. determining whether flow analysis within the tract can help predict disease before it occurs. Contour plots and vectors of velocity. Applications of the models may include accurately predicting velocity and wall shear stress within the tract. In particular. Non-Invasive Approa… fp . total pressure. and wall shear stress www. Cartesian coordinates used for two-dimensional cross section of healthy ureteral grid.org/research/re. Fluent 6.1. extending the numerical simulation to include the secondary flow effects. (Click image for larger version) The present study investigates a novel technique of urinary tract simulation in both healthy and symptomatic patients using CFD and quantitatively evaluates the diagnostic potential of computerized models.6 and simulated in Fluent 6. and flow was evaluated numerically by varying geometries and fluid properties. severity. as displayed in Figure 5.1. dynamic pressure. Table 1.org :: A Novel. static pressure. (Click image for larger version) METHODS All models were created in Gambit 2.1. and creating a virtual diagnostic tool that applies CFD to the urinary tract for the first time. determined via a 10:1 anatomical scaling in Gambit in conjunction with specific anatomical parameters.22. as expected. Both the abdominal and pelvic segments of the ureter are included. Coordinates were labeled A1-G1 and A2-G2 and connected via non-uniform Rational B-Splines.

as depicted in Figures 7 and 8. more accurately depicted the transverse variability in certain variables. dynamic pressure. www. Shown are the approximate measured contour values for velocity (in m/s). an inverse relationship between velocity and diameter illustrates the validity of conservation of mass.5/18/2011 JYI. Table 3. the standard k.2 kg/m3 and viscosity=0.solver was used. and total pressure (in Pa) at the inlet. Two major types of models were created: hypothetical and realistic.php?id=1518 6/29 . and site of constriction.001003 kg/(m*s). were used for Reynolds number calculations: density=998.org :: A Novel. Note that in some cases. Significantly higher magnitudes of velocity and pressure were measured in the turbulent case as compared to the laminar case because inlet velocities needed to be greater to accommodate larger Reynolds values.jyi. Non-Invasive Approa… were evaluated for each model. a range of values. second-order pressure and upwind momentum were used to minimize truncation and discretization errors. as previously assumed (Cummings et al. rather than a single value.000) cases (Fluent). outlet.org/research/re. (Click image for larger version) In Fluent. and second-order upwind was used for both k and . Path lines colored by particle identification and by velocity were also analyzed. urine properties were assumed to be those of liquid water. as such factors play a crucial role in clinical diagnosis. In the laminar model. The following properties of liquid water. 2004). obtained from the Fluent solver. For turbulence modeling. Numeric flow data for twodimensional cross section of control Venturi comparing the laminar (Re=700) and turbulent standard kepsilon (Re=5. From the relative velocities at the site of constriction. static pressure.

using Equation 6. Velocity contours of twowww. first angle (bend). more attention was paid towards investigating the physics of flow and its dynamicity. Coordinates were labeled A1R1 and A2-R2 and connected via nonuniform Rational B-Splines. Reynolds number was varied and simulated in the appropriate solver. spongy (penile) urethra (both bulbar and non-bulbar).1406732 and 1. membranous urethra. Non-Invasive Approa… Table 2.jyi. Reynolds values of 700 and 5.org/research/re.org :: A Novel.php?id=1518 7/29 . Cartesian coordinates used for two-dimensional cross section of healthy urethral grid.5/18/2011 JYI. respectively. and navicular fossa. based on variable geometries and boundary conditions. determined via a 20:17 anatomical scaling in Gambit in conjunction with specific anatomical parameters.0048087 m/s. Figure 12. Anatomical segments included in the model are the prostatic urethra. Note that each coordinate displayed in the table was multiplied by a factor of 20/17 prior to plotting in Gambit. Each model was further enhanced to more precisely apply to the human urinary tract. as displayed in Figure 6. In these models. inlet velocities were calculated to be 0. (Click image for larger version) Hypothetical Models The hypothetical models presented short segments of the urinary tract and potential geometric representations of obstruction. For all simulated models.000 were compared.

3 mm wide). the effects of wall shear stress generated on each side of the tract converge. thereby causing velocity to drop instantaneously to zero (complete obstruction).org/research/re. Non-Invasive Approa… dimensional cross section of obstructed cases of the urethra. such would yield fluid flow in the positive x direction with a specified velocity inlet. A Venturi with diameter of 5 mm was used. Contours are shown for the urethra as a 8/29 . Velocity contours and vectors of two-dimensional cross section of healthy urethra. As shown. This model was then simulated in Fluent.org :: A Novel.jyi. depending on the severity of the constriction. while red contours represent maximal values of velocity.5 mm deep. simulated in turbulent standard k-epsilon solver (Fluent).5/18/2011 JYI. however. simulated in turbulent standard k-epsilon solver (Fluent). Specifically displayed are the cases for bladder neck obstruction (a). The inlet edge designated the velocity inlet and the outlet edge the pressure outlet. as the diameter continues to narrow. www. and constriction was moderate (1. a 2D cross-sectional model was created (Figure 1) as a control. contours are magnified at respective sites of constriction. Blue contours represent minimal (zero) values. Trends illustrate that velocity continues to increase as diameter narrows. benign prostatic hyperplasia (BPH) (b). and bulbar spongy urethral (firstangle) constriction (c).php?id=1518 Figure 11. (Click image for larger version) 2D Cases Initially.

5/18/2011 JYI.jyi. Compared to the healthy ureter. with mildly and severely constricted models. Non-Invasive Approa… as a whole (a) and magnified at the bladder neck (b). for example. Finally. and UVJ constriction (c). while red contours represent maximal values of velocity. As shown. www.org Contours are shown for the urethra:: A Novel. Trend displays increased velocities in narrower regions of the urethra. The effect of constriction severity was also observed. Blue contours represent minimal (zero) values. Blue contours represent minimal (zero) values. Figure 10. constricted cases displayed decreased ureteral outflow. Velocity contours of twodimensional cross sections of obstructed cases of the ureter. contours are magnified at the outlets (ureterovesical junction) for the cases of UPJ constriction (a). constriction at the abdomino-pelvic junction (b). while red contours represent maximal values of velocity. with outlet velocity slightly greater than at the inlet. both constriction depth and width were considered.org/research/re. simulated in turbulent standard k-epsilon solver (Fluent). as shown in Figure 3. Figure 2 presents the case in which the distance is 6 mm. notable especially in the cases of UPJ and UVJ constriction. the effect of multiple constrictions and varying distances between them was studied.php?id=1518 9/29 . Vectors are shown for magnified region at the navicular fossa and urethral orifice (c) to display circulatory nature of flow. as expected. (Click image for larger version) The effect of varying the horizontal distance between the two constrictions from Figure 1 was initially observed by considering several cases of varying distance.

(Click image for larger version) Grid Independence Test To ensure consistency in the models. Such a test decreases the mesh spacing to a point such that further decreasing the interval would have a negligible effect on the outcome of a simulation while minimizing time and memory consumption. The 2D cases of variable constriction severity.org :: A Novel. In the 2D case. and an interval spacing of www. Non-Invasive Approa… (Click image for larger version) 3D Cases To construct the 3D cases. shows a 360-degree rotation of Figure 1. due to natural narrowing of the diameter. Velocity contours of twodimensional cross section of healthy ureter. it is important that a grid independence test be performed for both 2D and 3D cases.php?id=1518 10/29 . Mesh spacings of 1. and for magnified region at the ureteropelvic junction (UPJ.org/research/re. a triangular mesh was used with a symmetric Venturi. 0.125 were assayed with regard to velocity in the turbulence model. Contours are shown for the ureter as a whole (a). Blue contours represent minimal (zero) values. 0. as a finer grid yields greater accuracy. a tetrahedral mesh was used. Trend indicates a steady increase in urine velocity throughout the ureter from the UPJ to the UVJ. for example. while red contours represent maximal values of velocity.5. constriction multiplicity. inlet) (b) and ureterovesical junction (UVJ. outlet) (c). and distance between constrictions were rotated in a likewise fashion and simulated. while in the 3D case.5).25.5/18/2011 JYI. Figure 9. Figure 4.jyi. each of the 2D models was rotated 360 degrees about its horizontal axis of symmetry (y=2. and 0. simulated in turbulent standard k-epsilon solver (Fluent).

and total pressure are shown by respective contour plots. velocity and dynamic pressure display maximal values at site of constriction whereas static pressure is at a minimum. 3 mm wide). Blue contours represent minimal (zero) values. (Click image for larger version) Realistic Models In the realistic models. static pressure. The effect of the constriction on velocity.5/18/2011 JYI. Underdeveloped flow may also contribute to the observed distribution. Flow characteristics in turbulent standard k-epsilon solver (Fluent) for two-dimensional control Venturi. However. complete ureters and urethras were modeled.5 was ultimately selected for all 2D and 3D cases. dynamic pressure.000 based on inlet velocity. As in the laminar solver.5 mm deep. and are shown for comparison to fluid dynamics of the same model in the laminar solver (Re=700). Non-Invasive Approa… 0. Figure 8.org/research/re.jyi. the non-symmetric distribution of contours is a result of the turbulent nature of the flow. while red contours represent maximal values. Reynolds number was 5. Both healthy and obstructed models were created and compared to experimental data to assess accuracy 11/29 In www.org :: A Novel.php?id=1518 . and constriction was of moderate severity (1.

possibly an effect of flow that has not developed fully.org :: A Novel. static pressure. despite the laminar flow profile. The effect of the constriction on velocity.org/research/re. JYI.5/18/2011 obstructed models were created and compared to experimental data to assess accuracy. Note that. Velocity and dynamic pressure display maximal values at site of constriction. Non-Invasive Approa… Figure 7.166 m/s (Re=9. dynamic pressure.model was used for all realistic simulations. contours appear to drift upwards. In Fluent. an inlet velocity of 0.swf.826. Reynolds number was 700 based on inlet velocity. and 1.php?id=1518 Ureter A ureteral model was created from scaling an anatomical diagram (available at http://www.556.org. based on realistic urine velocity data obtained in humans (Hashimoto 1992). while red contours represent maximal values.409 for liquid water using Equation 6) was used for the ureter. 3 mm wide). Blue contours represent minimal (zero) values. and constriction was of moderate severity (1. (Click image for larger version) www. Flow characteristics in laminar solver (Fluent) for twodimensional control Venturi.5 mm deep. bends and diametric narrowings (Standring 2005) were used to establish Cartesian coordinates to be plotted in Gambit (Table 1) 12/29 . whereas static pressure is at a minimum. The standard k.jyi.400) was used for the urethra.uco.au/images/urology. Urological Cancer Organisation) of the urinary system.284 m/s (Re=2. Additional anatomical information regarding specific lengths. the scale ratio was measured to be 10:1. and total pressure are shown by respective contour plots.

5/18/2011 establish Cartesian coordinatesJYI. and red line designates pressure outlet (ureterovesical junction. Non-uniform Rational B Splines were 13/29 . to be plotted in Gambit (Table www. Non-Invasive Approa… 1).org/research/re. blue line designates velocity inlet (ureteropelvic junction. Green lines represent triangular mesh (0. determined by grid independence test). Coordinates were labeled A1-G1 and A2-G2. created via a 10:1 anatomical scaling in Gambit.jyi.5 spacing.php?id=1518 Figure 5. edge G1G2). edge A1A2). Cartesian coordinates used are presented in Table 1. Twodimensional cross sectional healthy model of the ureter.org :: A Novel. Abdominal and pelvic segments of ureter connect at C1 and C2.

Edge A1A2 was the ureteropelvic junction (UPJ) and velocity inlet.jyi. Figure 6. Coordinates were labeled A1R1 and A2-R2. The coordinates were connected via non-uniform Rational B-Splines (NURBS). A triangular mesh of 0.5 spacing was used to create the healthy 2D ureteral model (Figure 5). and the pelvic ureter from C1C2 to G1G2. Two-dimensional cross sectional healthy model of male urethra. Non-Invasive Approa… Coordinates were labeled A1-G1 and A2-G2. (Click image for larger version) JYI.org :: A Novel. All edges other than A1A2 and G1G2 were walls.org/research/re. Green lines represent triangular mesh www. created via a 20:17 anatomical scaling in Gambit.5/18/2011 Rational B-Splines were used to connect ureter walls. and edge G1G2 was the ureterovesical junction (UVJ) and pressure outlet. Cartesian coordinates used are presented in Table 2. Model was subsequently simulated in Fluent.php?id=1518 14/29 . The abdominal ureter length spanned from A1A2 to C1C2. as displayed in Table 1. A1G1 and A2G2.

the model could not be simulated in Fluent. A1R1 and A2R2. Non-uniform Rational B-Splines were used to connect urethra walls. (Click image for larger version) JYI.org :: A Novel. and red line designates pressure outlet (urethral orifice. Non-Invasive Approa… 3D The 2D model could not be revolved 360 degrees about its center. so a hexahedral mesh with a Cooper meshing scheme and 0.5 spacing was used. skin surfaces in the z-plane were created and combined. blue line designates velocity inlet (bladder neck. as Gambit prohibits revolution of faces about a twisted or scrunched edge. Model was subsequently simulated in Fluent.php?id=1518 15/29 . Venturi diameter was 5 mm and constriction diameter was 1. Instead. The volume could not be meshed using a tetrahedral mesh. edge A1A2). the grid check failed and immediate divergence was detected. Navicular fossa is encompassed by segment PR. and membranous urethra conjoins spongy (penile) urethra at point H. Although the mesh was successfully exported to Fluent.jyi. Prostatic urethra conjoins membranous urethra between points G and H.5 mm deep and 3 mm wide (moderate).5/18/2011 represent triangular mesh (0. edge R1R2). Model was created in www.5 spacing.org/research/re. determined by grid independence test). Three-dimensional control grid with symmetric constriction. Figure 4.

3 mm wide). SUNY Downstate Medical Center). C1C2 was reduced to 1 mm.5 mm deep.5/18/2011 ( ) JYI. For obstruction at the abdomino-pelvic junction. Model was subsequently simulated in Fluent. and red face designates pressure outlet. relative to control case. the scaled ratio was measured to be 20:17. Non-Invasive Approa… Gambit by rotating respective twodimensional cross sectional grid 360 degrees about the horizontal line of symmetry. blue face designates velocity inlet. As males www. Specifically shown.downstate.org/research/re. G1G2 was reduced to 0. For UVJ obstruction. For UPJ obstruction. Model was created in Gambit for subsequent simulation in Fluent. segment A1A2 was reduced to 1 mm. a distance of 6 mm spans between two moderate constrictions (1.5 mm.jyi. blue line designates velocity inlet. (Click image for larger version) Urethra A urethral model was created from scaling a male urethra in a similar fashion as used for the ureter (available at http://ect.org :: A Novel. all other factors were held constant. Black lines represent tetrahedral mesh.edu/courseware/haonline/figs/l44/440408. Figure 2. and red line designates pressure outlet. and the abdomino-pelvic ureteral junction (Resnick and Sutherland 2004).php?id=1518 16/29 . UVJ.htm. (Click image for larger version) Obstructed Models Three areas of the ureter are most susceptible to obstruction: the UPJ. Green lines represent triangular mesh. Two-dimensional cross section of grid with variable distance between constrictions.

Specifically shown. Green lines represent triangular mesh.org/research/re. and J1J2 represented the first angle or bend. and edges other than A1A2 and R1R2 were walls. Figure 3.php?id=1518 17/29 .5 mm deep. The effects of both constriction severity (depth. two constrictions with a medium spanning distance and moderate constriction (1. The membranous urethra followed the prostatic for 15 mm. The spongy or penile urethra spanned from H1H2 to P1P2 (bulbar from H1H2 to L1L2 and non-bulbar from L1L2 to P1P2). blue line designates velocity inlet. Segment A1A2 was the bladder neck and velocity inlet. 3 mm wide). Non-Invasive Approa… are more susceptible to urethral obstruction than females. The prostatic urethra spanned from A1A2 to the midpoint of segments G1G2 and H1H2. bends and diametric narrowing (Standring 2005) was used to establish Cartesian coordinates to be plotted in Gambit (Table 2). until segment H1H2. and red line designates pressure outlet.5/18/2011 JYI. only models of the male urethra were created. Additional anatomical information regarding specific lengths. and the urethral orifice (R1R2) was a pressure outlet. Each coordinate in the table was multiplied by 20/17 before plotting to account for the scale ratio. www.jyi.5 spacing was used to create the 2D healthy model (Figure 6).org :: A Novel. width) and distance were assessed. A triangular mesh with 0. Two-dimensional cross section of grid with multiple constrictions and variable distances between them. P1P2 to R1R2 represented the navicular fossa. The coordinates were connected via NURBS. Model was created in Gambit for subsequent simulation in Fluent (Click image for larger version) Coordinates were labeled A1-R1 and A2-R2.

creation of a skin surface in the z-plane could not be completed. All other factors were held constant.org :: A Novel. prostate cancer. All models were simulated.org/research/re. prostatic urethra and first angle (bulbar spongy urethra) (Resnick and Sutherland 2004). For this model. However. or other diseases of the prostate gland may cause constriction along the prostatic urethra. In the model of first angle obstruction. Non-Invasive Approa… Equation 1 (Click image for larger version) 3D Gambit prohibited a 360-degree revolution of the 2D model. Obstruction at the first angle occurs in the bulbar portion of the spongy urethra. A 3D model was unable to be created in Gambit using the employed methods.php?id=1518 18/29 . 2D crosssectional models for each obstructed case were created and simulated. Equation 2 (Click image for larger version) Obstructed Models Three areas of the urethra are most susceptible to obstruction: the bladder neck. An attempt to create multiple volumes along the tract by revolving individual segments by 360 degrees and subsequently merging them also failed.5/18/2011 JYI. the bulbar penile urethra diameter was reduced to 1 mm.jyi.5 mm. Benign prostatic hyperplasia (BPH). the inlet diameter was reduced to 0. An attempt was made to create a 3D model in a similar fashion as in the ureteral model.5 mm. www. the diameter of the prostatic urethra was reduced to 0. For the obstructed bladder neck case.

with particular focus on the flow at the inlet.jyi. fluid dynamics were evaluated with regard to velocity. In particular. and outlet regions. Path lines and contour plots indicated a decreased output of urine in response to greater magnitudes of constriction.000). in the laminar solver. as observed in Table 3.5/18/2011 JYI. dynamic pressure. Non-Invasive Approa… Equation 3 (Click image for larger version) RESULTS Hypothetical Models In the hypothetical models. Equation 4 (Click image for larger version) The data indicates similar trends between the laminar and turbulent solvers. constricted.5-fold difference. and total pressure. Figure 7 displays the flow characteristics in the 2D cross-sectional control Venturi model with moderate constriction severity utilizing a laminar solver (Reynolds value of 700).org/research/re. Figure 8 displays flow characteristics in the control model utilizing a turbulent solver (Reynolds value of 5. By comparison. For example.40 m/s in the turbulent solver corresponds to a 2. Numerical values of velocity and pressure derived from these models. an inlet velocity of 0.141 m/s corresponds to a constriction velocity of 0.356 m/s. a constriction velocity of 2.org :: A Novel. Values presented in Table 3 are representative approximations based on contour plot scales. approximately a 2. static pressure. are tabulated in Table 3.php?id=1518 19/29 . Likewise.4-fold difference over the www. greater velocities and dynamic pressures were noted at constricted regions relative to those at the inlet along with corresponding negative static pressures.

org :: A Novel.php?id=1518 20/29 . Contours of velocity and pressure at the corresponding regions of constriction were shown to be similar in the cases with a smaller gap between constrictions and those with larger gaps. The effect of varying distances between constrictions in a doubly-constricted case (as in Figure 3) displayed no significant effect on flow characteristics.5/18/2011 inlet velocity of 1. abdomino-pelvic ureteral. illustrating similarity between the trends in the two solvers. www.jyi. Figure 10 displays the velocity contours at the UVJ for the cases of UPJ.org/research/re. Furthermore.284 m/s converged in all cases. JYI. Figure 9 displays the velocity contours observed in the healthy ureteral model. and constriction severity. Velocity increased steadily throughout the tract from the UPJ to the UVJ. from which pressure contours could be deduced. Inlet and outlet velocities are tabulated for each case in Table 5. more emphasis was placed on contours of velocity. and severe cases of obstruction. pressure magnitudes.00 m/s. moderate. and UVJ obstruction. magnified at the inlet and outlet. outlet flow conditions were similar to those observed in the control case. Selected inlet values of 0. Equation 6 (Click image for larger version) Realistic Models Ureter In the realistic models. Non-Invasive Approa… Equation 5 (Click image for larger version) Table 4 displays the effect of constriction severity on the control model for mild. The data illustrates a direct correlation between velocity.

Non-Invasive Approa… The data demonstrates that all diseased states decreased ureteral outflow.org :: A Novel. Corresponding velocity contours in each of the obstructed cases at the sites of constriction—bladder neck constriction. only the case of bulbar spongy urethral obstruction could converge at the anticipated 1. UPJ and UVJ constriction had more profound effects. Equation 7 (Click image for larger version) Urethra Contours and vectors of velocity are shown for the healthy urethral model (Figure 11) with magnifications at the bladder neck (inlet) and navicular fossa (outlet).166 m/s inlet value. Equation 8 (Click image for larger version) DISCUSSION www. and bulbar spongy urethral constriction—are displayed in Figure 12.0 m/s was specified in the healthy model for convergence of the solver. Additionally. An inlet velocity of 5.jyi. whereas the case of abdomino-pelvic ureteral constriction only slightly decreased outlet velocity. BPH. Inlet and outlet velocities are tabulated in Table 6 for each case. In particular.php?id=1518 21/29 .org/research/re. All other cases required a higher inlet velocity specification in Fluent. JYI.5/18/2011 converged in all cases. Table 6 indicates relatively higher outlet flow velocities in comparison to those at the inlets in all cases except for bladder neck constriction.

Venturi diameter was 5 mm and constriction diameter was 1. For example. evaluated theoretical possibilities of lower urinary tract simulation using a hydrodynamic model (1991). Non-Invasive Approa… A recent study (Martinez-Borges 2006) proposed turbulent urinary flow as a causal factor of BPH. Valentini et al. Witjes et al. van Mastrigt and Kranse 1992. Model was created in Gambit for subsequent simulation in Fluent. blue line designates velocity inlet. Ohnishi et al. The Newtonian quality of urine explains the direct relationship between velocity and wall shear stress. the Valentini-Besson-Nelson model focuses more on physiological uroflow curve interpretation. Equation 2. and red line designates pressure outlet. suggesting the necessity to conduct investigations of urethral fluid dynamics. The NavierStokes conservation of mass equation. and hence why the velocity at constricted points was relatively greater than at the inlet. with slightly different objectives.jyi.5 mm deep and 3 mm wide (moderate). explains the inverse relationship between velocity and area. 2002. However. a simplification of the NavierStokes equations. Previous studies have developed both quantitative and computerized models to assess the flow of urine in the lower urinary tract. relates velocity and pressure.5/18/2011 JYI.org :: A Novel. similar quantitative studies regarding urodynamic models and pressure-flow analysis have been suggested as well (Chamorro et al. Pel and van Mastrigt 2007). www. (Click image for larger version) Hypothetical Models Flow proved consistent with CFD equations and basic fluid flow theory. The Navier-Stokes conservation of momentum equation. Green lines represent triangular mesh. further explains the static-dynamic pressure relationships.org/research/re. Two-dimensional cross section of control grid with symmetric constriction. developed a computerized mathematical micturition model capable of analyzing physiological changes during voiding (2000) and applied their model to benign prostatic enlargement using pressure-flow analysis (2003). Equation 1.php?id=1518 22/29 . Figure 1. and the Bernoulli equation. 1998.

and Equations 7 and 8 were used to determine the necessary entrance length for the flow to fully develop (210 mm inlet for Re=700 and 90. In the cases of bladder neck obstruction and BPH stagnant flow was observed similar to the 23/29 www. increased until a point at which the effect of the two walls converged due to the severity of the constriction. under the given boundary and operating conditions. as illustrated by velocity contours in Figures 9 (a-c) and 10 (a-c). This may be a result of body force.php?id=1518 . as seen in Figures 11 (a-c) and 12 (a-c). Greater relative outlet and constriction velocities were observed and expected.000). initiated by the Newtonian property of urine. possibly due to geometric complexity. Realistic Models Ureter CFD equations accurately predicted the flow through the healthy and obstructed ureteral models with regard to diametric changes. Interestingly. Urethra In both the healthy and obstructed urethral models. and reversed flow was eliminated. Further. The data indicates that the effect of wall shear stress. Such suggests that. Non-Invasive Approa… Figures 7 and 8 indicate that the flow was not symmetric despite symmetric geometry. Reversed flow was present in some models. such differences were expected due to differences in the equations used by the two Fluent solvers. but results proved quite similar to those of the 2D models. based on velocity-area relationships (greater velocity at the urethral orifice than at the bladder neck) and decreased output from constriction.org/research/re. urine would be unable to flow beyond the point of obstruction unless ureteral pressure is increased. the velocity increased before the outlet until a certain point. Although slight differences were noticed between 2D and 3D results. All 3D models were simulated in the turbulence solver. in UVJ obstruction (Figure 10 (c)).jyi. The concept of fully developed flow was considered for eliminating such flow. 3D cases had also taken secondary flows into account. Additionally.org :: A Novel. The models were modified. The 3D cases were evaluated in a similar fashion as the 2D cases.974 mm inlet for Re=5. due to the natural diametric narrowing of the tract. convergence in the laminar solver was restricted in most models for both Reynolds values.5/18/2011 JYI. flow was also predictable. similarities between 2D and 3D hypothetical model results indicate that the 2D ureteral models can accurately represent 3D cases of the ureter that could not be simulated. after which it became zero.

then an inlet of 1. Such is a possibility for the lower inlet values.166 m/s.solver would be better for circulatory flow analysis than the standard k. however. In the bladder neck obstruction and BPH models. if a more severe case of first-angle constriction were used. It is possible for involuntary flow (leaks) to occur in incontinent patients. in which the flow velocity is typically much less than in healthy patients. for the first-angle case. this was caused by constriction severity and wall shear stress and can be eliminated by increasing detrusor pressure. Interestingly. geometry. and convergence. However.963.166 m/s would not converge. Theoretical analysis was assessed using CFD equations and flow theory. since the constriction was not as severe. as expected.org :: A Novel. Detrusor pressure possibly accounts for the higher inlet velocity. the flow converged at an inlet of 1. since the diameter of the bulbar urethra was reduced. In the healthy model. however. similar to the case of UVJ obstruction.432) converged. there was no stagnant flow under the simulated conditions. Varying the inlet velocity only affected the circulatory flow within the navicular fossa.model.5 m/s (Re=36.jyi. Again. as the RNG equations would more accurately model swirling flow.php?id=1518 24/29 .166 m/s.51 m/s (Re=36. indicating a potential relationship between Reynolds number. stagnant flow was observed. further accuracy in a clinical setting can be evaluated by comparing Fluent results to experimental uroflowmetry data. A possible explanation is that in the healthy model. however. An inlet velocity of 4. yielding the possibility of convergence at 1. while flow throughout the rest of the urethra.166 m/s. even greater velocity inlets were required for convergence.org/research/re. the bulbar urethral diameter was so great that a greater Reynolds number was necessary for convergence. and the solution did not converge. remained consistent.881. the Reynolds number calculation was affected. which occurred at 5 m/s (as in Figure 11). Inlet velocity was varied and assayed at increasing integer quantities until convergence. as such would enable urine flow from inlet to outlet. yet relative fluid dynamics remain consistent. JYI. but in the first-angle constriction case.1 m/s.473) diverged. Interesting results were obtained from varying inlet velocities in all models. a floating point error was detected at an inlet velocity of 1. In the model of first-angle constriction. the solution also converged at inlet values less than 0.5/18/2011 cases of bladder neck obstruction and BPH. including the orifice. Supposedly. but an inlet of 4. A Re-Normalization Group (RNG) k. Non-Invasive Approa… Comparison to Experimental Data and Clinical Applications Normal uroflow volume rates in men between 4 and 80 years of age range from 9 to 21 cm3/sec depending on age (Gilbert 2004) To calculate the outlet velocity in cm/sec www.

Non-Invasive Approa… Challenges and Limitations for Future Consideration Indeed.024446 cm2. which limits realistic modeling. By analyzing the differences in outlet flow values for each case of obstruction.org/research/re. Convergence difficulties in the laminar and turbulent solvers and difficulties in the grid independence tests for very fine meshes still require further investigation. the models can be used in conjunction with current imaging techniques to potentially pinpoint the exact location and type of urinary obstruction in patients. which are slightly higher than predicted. each model can be varied to model patient-specific urinary tract parameters for more precision in clinical applications. as MRI’s and CT scans do not typically cover the complete urinary tract and the cropping and exportation processes would require www. Programs other than Gambit and Fluent.68 m/s) to 859. are currently being investigated to simulate MRI’s and CT scans of the tract using fluid-structure interaction (FSI). The chosen turbulent solver (standard k-ε) may be varied for additional accuracy.org :: A Novel. depending on age (Gilbert 2004). Creation of the models was based on a Cartesian approach in Gambit. Realistic outlet velocities hence range from 368.036 cm/sec (8.solver would provide greater precision in the analysis of swirling flows. Nonetheless. accurate modeling of the urinary tract with the given procedures is restricted by variation in urinary tract parameters and in the urethral lumen diameter (wall compliance). To calculate the outlet velocity in cm/sec.59 m/s) with the given parameters. determining the density and viscosity of urine would alter Reynolds number calculations and yield more realistic results. Further minimization of truncation and discretization errors as well as reversed flow would even further improve accuracy.5/18/2011 cm3/sec. whereas the human urinary tract displays wall compliance.jyi. JYI.158 cm/sec (3. A urethral orifice radius of 0. especially in the 3D cases.9 m/s. such as Amira and ADINA. Clinically.91 and 16. use of the RNG k. Figure 11 (c) indicates that an inlet velocity of 5 m/s yielded outlet velocities between 6. respectively. yielding an orifice area of 0. Additionally. the CFD models may extend the current diagnostic potential of uroflowmetry tests by incorporating such factors as static and dynamic pressure as well as velocity output. uroflow values were divided by the cross sectional area of the outlet (in cm2). Such programs may present a drawback. Additional experimental data must be obtained for greater accuracy. This suggests that increasing the diameter of the urethral models and decreasing the inlet velocity would yield more realistic outlet values. several points of concern exist for future improvements. Urinary tract walls were also rigid in Fluent. For example.php?id=1518 25/29 . for example.088235 cm was used in the healthy urethral model. however.

J Fluid Mechanics 533(1). Gilbert. Non-Invasive Approa… REFERENCES Blackburn. Ann Rev Fluid Mechanics 32. http://www. JYI. Chamorro.S. U. Elad. MedlinePlus Medical Encyclopedia. CFD was applied to the urinary tract as a whole to create a non-invasive diagnostic tool for urinary tract obstruction in both the ureter and urethra. Hinyokika Kiyo 38(5). M and Y Hel-Or (2001) A Fast Super-Resolution Reconstruction Algorithm for Pure Translational Motion and Common Space Invariant Blur. Jou. (2004) The effect of ureteric stents on urine flow: reflux. The flow was evaluated through constricted tubes. MV et al. 297-327.org :: A Novel. The models have implications for clinical applications of urinary tract analysis. SM (2004) Uroflometry. and attention was paid to the effects of such constriction and to variable geometries and fluid properties. HM and SJ Sherwin (2005) Three-dimensional instabilities and transition of steady and pulsatile axisymmetric stenotic flows. J Math Biol 49. LJ et al. (1992) Visualization of the intravesical urine stream. www. 531-534.5/18/2011 cover the complete urinary tract and the cropping and exportation processes would require numerous hours. The present study analyzed the fluid dynamics of urine inside the urinary tract. diagnosis. 56-82. Arch Esp Urol 51(10).nlm. Nonetheless such programs would provide for more patient-specific variation in urinary tract parameters. 1011-1020. LD and SA Berger (2000) Flows in stenotic vessels.htm. secondary flow effects. Cummings. IEEE Trans Image Process 10(8). For the first time. 347-382. (1998) Urodynamic models in the analysis of pressure-flow studies in the adult male.php?id=1518 J H t l (2004) A t i fl f N t i fl id i ti t d 26/29 .jyi. 1187-1193. National Library of Medicine.nih.gov/medlineplus/ency/article/003325. National Institutes of Health. T et al. Hashimoto. and possible disease prevention by early detection.org/research/re.

eMedicine Clinical Knowledge Base. Lim. http://www. New York: Churchill Livingstone 1600 p www. (2004) Asymmetric flows of non-Newtonian fluids in symmetric stenosed artery. 631-636. Luo. Phys Med Biol 25(4).5/18/2011 Jung. Pel.org/research/re. (1998) Experimental analysis of unsteady flows through a stenosis. 13-23. 2005.jyi. Kim. 101-108. H et al. JJM and R van Mastrigt (2007) Development of a CFD urethral model to study flowgenerated vortices under different conditions of prostatic obstruction.php?id=1518 27/29 . 11-9. 39th ed.com/med/topic2782. (1991) A study of the simulation model of the lower urinary tract for urodynamics--(the first report)--theoretical evaluation of hydrodynamic model. Hinyokika Kiyo 37(10). Non-Invasive Approa… Standring S. (1997) Limitations of Temporal Resolution in Functional MRI. 403-413. JYI.emedicine. Martinez-Borges. Magn Reson Med 37(4). 1913– 1922. Medical Hypotheses 67(4). 1249-1253. M et al. S and H Yeshurun (2001) Superresolution in MRI: Application to Human White Matter Fiber Tract Visualization by Diffusion Tensor Imaging. Magn Reson Med 45. 2935. K et al. Medical Engineering and Physics 26(5). Ohnishi. WebMD. M and S Sutherland (2004) Urinary Tract Obstruction.htm. BM (2003) Mechanical factors in the production of atheromatous disease with a critique on antilipid therapy. Physiol Meas 28. (2004) LES modelling of flow in a simple airway model. 871-875. Peled. Cardiovascular Engineering: An International Journal 3(1). K et al. (1980) Analysis of mitral and aortic valve vibrations and their role in the production of the first and second heart sounds. Siouffi. XY et al. RuDusky. RC et al. J Biomechanics 31.org :: A Novel. (2004) The flow of bile in the human cystic duct. 727-733. J Biomechanics 37. 3944. Ooi. Resnick. SG et al. Korea-Australia Rheology Journal 16(2). Gray’s Anatomy: The Anatomical Basis of Clinical Practice. AR (2006) Turbulent urinary flow in the urethra could be a causal factor for benign prostatic hyperplasia.

Gk is the generation of turbulence kinetic energy due to the mean velocity gradients. (2000) A mathematical micturition model to restore simple flow recordings in healthy and symptomatic individuals and enhance uroflow interpretation. Neurourol Urodyn 19(2). In these equations. defined in Equation 6. R and M Kranse (1992) Analysis of pressure-flow data in terms of computer-derived urethral resistance parameters. fi are body forces (such as gravity). JYI. This model is appropriate for fully-turbulent flows in which molecular viscosity is negligible. is used to determine whether flow is laminar (usually Re < 2 000 for an internal flow) turbulent (usually Re > 4 000 for an 28/29 www. ui (i = 1. and its dissipation rate. Viscous. Gb is the generation of turbulence kinetic energy due to buoyancy.5/18/2011 New York: Churchill Livingstone. and SK and Sε are user-defined source terms. linear relationship between shear stress and the velocity gradient. can be obtained.php?id=1518 .jyi. The Reynolds number (Re). (2002) Computerised assessment of maximum urinary flow: an efficient. ρ is the density. 1600 p. σK and σε are the turbulent Prandtl numbers for k and ε. (2003) Modelized analysis of pressure-flow studies of patients with lower urinary tract symptoms due to benign prostatic enlargement. from which turbulence kinetic energy. Non-Invasive Approa… Valentini.org :: A Novel. Eur Urol 41(2). In these equations.2. C2ε. Such equations were applicable since the viscosity and density of the working fluid were treated as a constant. FA et al. and valid approach. The standard k-epsilon (k-ε) model was used for assessing turbulent flow.3) are the three components of velocity. Appendix: Governing Equations and Additional Formulas Urine is a Newtonian fluid. k. The solver was chosen as it is the most practical and basic solver for engineering and CFD applications and purposes. incompressible Newtonian fluids are governed by the Navier-Stokes equations (Equations 1. Witjes. Valentini. one in which there is a simple. World J Urol 13(1). ε . Neurourol Urodyn 22(1). consistent. WP et al. Two transport equations (Equations 4 and 5) are involved in this model. and µ is the constant viscosity of the fluid. 205-213. p is the pressure. Ym represents the contribution of the fluctuating dilatation in compressible turbulence to ε. van Mastrigt. and C3ε are constants. respectively. 40-46. 2. 45-53. and 3).org/research/re. FA et al. C1ε. 153-176.

22 and Gambit 2. All rights reserved. 2010. Volume 18. JYI.org/research/re. Journal of Young Investigators. Wayne State University) for their technical assistance throughout the duration of the present work.org :: A Novel. turbulent (usually Re > 4. such as geometric complexity. Copyright © 2011 Nirmish Singla and JYI.000 for an internal flow). MD (Department of Urology. What is JYI? JYI's mission JYI's history FAQ Support JYI Staff www. PhD (Department of Mechanical Engineering.1. A flow must be fully-developed within a tube before a constricted area in order to ensure accuracy. determination of turbulence varies with other factors. as shown in Equations 7 and 8. Appreciation is given to mentors Joon Sang Lee.php?id=1518 29/29 .jyi. Non-Invasive Approa… ACKNOWLEDGEMENTS Access to Fluent 6.000 for an internal flow).1.5/18/2011 laminar (usually Re < 2. As Re is just an approximation.6 provided by the CFD laboratory in the Department of Mechanical Engineering at Wayne State University is gratefully acknowledged. Wayne State University) and Ajay Kumar Singla.000 less than or equal to Re which is less than or equal to 4.000). or transitional (2. The formulas for the inlet length of a tube for full flow development are based on Re (laminar or turbulent flow) and tube diameter.

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