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Malde S, Belal M, Mohamed-Ahmed R, Gibson W, Padilla-Fernandez B, Rantell A, Selai C, Solomon E, Abrams P. Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023. Neurourol Urodyn 2024; 43:1353-1362. [PMID: 37905437 DOI: 10.1002/nau.25324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
AIMS The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. METHODS The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. RESULTS There is no consensus on the threshold value of PVR that is considered "elevated" or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. CONCLUSIONS There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated" or "significant" PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mo Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Barbara Padilla-Fernandez
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Caroline Selai
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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El-Tholoth HS, Alsulihem A. Bladder outflow obstruction in women: Clinical and basic evaluation. Neurourol Urodyn 2024. [PMID: 38197725 DOI: 10.1002/nau.25386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
AIM Female bladder outflow obstruction is an underdiagnosed and undermanaged condition. This review article aims to illustrate the basic and clinical evaluation of patients who might have this condition. REVIEW Clinical evaluation includes clinical history, examination, and basic investigations, including uroflowmetry and postvoid residual, urinalysis and culture, renal function assessment, ultrasound of kidneys and bladder, voiding cystourethrography, and magnetic resonance imaging. Based on the initial evaluation, if the concern of obstruction is high, the clinician might undergo further advanced evaluation. CONCLUSION Basic evaluation is the initial step in the diagnosis of female bladder outflow obstruction, the clinician need to have a high index of suspicion and often further advanced evaluation is needed to confirm the diagnosis.
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Affiliation(s)
- Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Alsulihem
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Cetinkaya SE, Urcun MT, Seval MM, Varli B, Dokmeci F. Impact of pelvic floor distress on non-invasive urodynamic findings in women. Eur J Obstet Gynecol Reprod Biol 2023; 284:105-109. [PMID: 36966588 DOI: 10.1016/j.ejogrb.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE (S) To compare non-invasive urodynamic findings in women with and without pelvic floor distress and to investigate the patient characteristics affecting maximum flow rates. STUDY DESIGN This is a retrospective study including data derived from a prospective cohort study evaluating free uroflowmetry findings in asymptomatic and symptomatic women with urinary dysfunction attending the gynecology outpatient clinic for routine annual control, infertility, abnormal uterine bleeding and pelvic floor dysfunction. Data regarding baseline characteristics, questionnaires, urogynecologic examination findings and free uroflowmetry results were retrieved. Women were grouped according to the Turkish validated Pelvic Floor Distress Inventory (PFDI-20); women who scored 0 or 1 points for each item ("no" or "not at all") were considered as asymptomatic in terms of pelvic floor dysfunction, and women who scored 2 or more points to any item were accepted as symptomatic. Baseline characteristics, clinical examination findings and free uroflowmetry data were compared among the groups using Student's-t or Mann-Whitney U tests, Chi-square test or Fisher's exact tests, where appropriate. Correlations and their significance, and patient characteristics affecting Qmax were investigated using the Pearson test. A multiple linear regression model was used to identify independent factors affecting Qmax. RESULTS The study population (n = 186) comprised asymptomatic (n = 70, 37.6%) and symptomatic (n = 116, 62.4%) women according to the scores of the PFDI-20. Corrected Qmax, TQmax, Tvv and PVR were found significantly lower in asymptomatic women (p ≤ 0.001). In asymptomatic women, PVR was <100 mL in 98.5%, and <50 mL in 80%. In multivariate linear regression analysis parity, obstructive subscale score of the UDI-6, previous mid-urethral sling surgery and hysterectomy were found to affect Qmax negatively, whereas VV was found to affect Qmax positively. CONCLUSION(S) Although significantly different, overlapping wide ranges of non-invasive urodynamic findings have been observed in women with and without pelvic floor distress in the present study population. Maximum urinary flow rates were significantly affected by patient characteristics such as parity, obstructive symptoms, prior incontinence surgery and hysterectomy. There is need for further larger studies considering all possible factors that may affect voiding.
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Affiliation(s)
- Serife Esra Cetinkaya
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Merve Toy Urcun
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Murat Seval
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Bulut Varli
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Fulya Dokmeci
- Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual. Female Pelvic Med Reconstr Surg 2021; 28:45-48. [PMID: 33886511 DOI: 10.1097/spv.0000000000001062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the accuracy of postvoid residual (PVR) by subtraction as compared with objective measurement by bladder scan or catheterization. METHODS This is a secondary analysis of postoperative patients who underwent avoiding trial by retrograde bladder instillation. Fill volume, spontaneous voided volume, and PVR were objectively measured; PVR was also calculated. Pearson correlation compared PVR by subtraction versus objective measurement. We then defined postoperative urinary retention (POUR) at 3 different PVR values (100 mL, 150 mL, and 200 mL) to compare the sensitivity, specificity, and positive and negative predictive values of subtraction for detecting urinary retention at these 3 thresholds. RESULTS Data were available for 155 patients after urogynecologic surgery. Median PVR by objective measurement was 46 mL (interquartile range = 11-146 mL). Median calculated PVR by subtraction was 10 mL (interquartile range = 0-100 mL). Objective measure and subtraction PVR values were strongly correlated (Pearson coefficient = 0.78, P < 0.001). Using a threshold of 200 mL to define POUR resulted in the highest negative predictive value and the lowest absolute number of both false negatives and false positives. Even using this threshold, 11 (48%) of 23 women with POUR by measurement were misclassified as not having POUR when ascertained by subtraction. CONCLUSIONS Although subtraction PVR correlates well with objective PVR measurement, almost half of women with a PVR volume of greater than 200 mL by objective measurement are miscategorized as voiding normally by subtraction PVR. Based on these findings, reliance on objective PVR measurement in postoperative patients is preferable to subtraction PVR.
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Ton J, Downing P, Versi E, van Uem S, Ephraim S, Murphy M, Lucente V. Outcomes of a single trigone-only vs. 20 trigone-sparing injections of OnabotulinumtoxinA for refractory overactive bladder (OAB). Int Urol Nephrol 2021; 53:1067-1072. [PMID: 33742316 DOI: 10.1007/s11255-021-02802-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare the safety and durability of a single intravesical trigonal-only versus 20 trigone-sparing injections of OnabotulinumtoxinA (BTA) for refractory OAB. METHODS A chart review of all idiopathic OAB patients treated with BTA from January 2016 to December 2018 was performed. Outcomes measures included: inter-injection interval, post-void residual (PVR), urinary tract infections (UTI), urinary retention requiring catheterization, and procedure time (min). Statistical analyses were performed using independent sample t-tests. RESULTS Baseline characteristics were comparable for the two groups, data on 69 treatments (19 patients trigone-only) were compared to 105 treatments (26 patients trigone-sparing). There were no differences in the inter-injection intervals or rates of UTI. The trigone-only group exhibited a lower mean PVR (113 ml vs 160 ml, p < 0.02), lower proportion with PVR > 150 ml (23% vs. 39%, p < 0.03), lower rate of urinary retention (5.3% vs. 17.4%, p < 0.02), and shorter procedure time (4.3 min vs. 5.7 min, p < 0.01). There were no cases of vesico-ureteral reflux. CONCLUSION While interpretation remains speculative, the results of this observational study suggest that a single trigone-only injection appears to be as safe and durable as multiple trigone-sparing injections but maybe quicker to perform and appears to have a lower impact on voiding function. Larger series and adequately powered prospective randomized clinical trials are warranted to validate the findings of this pilot study.
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Affiliation(s)
- Jessica Ton
- Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Eboo Versi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Stefanie van Uem
- Department of Urology, Stanford University School of Medicine, San Francisco, USA
| | | | - Miles Murphy
- Institute for Female Pelvic Medicine, Allentown, PA, USA
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Urinary retention is rare after colpocleisis and concomitant midurethral sling: a 10-year experience. Int Urogynecol J 2021; 32:729-736. [PMID: 33547907 DOI: 10.1007/s00192-021-04705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The optimal method of managing stress urinary incontinence (SUI) in women undergoing colpocleisis remains unclear, especially in a setting of urinary retention. We aim to compare postoperative retention after colpocleisis with or without concomitant midurethral sling (MUS). METHODS A retrospective chart review of all women who underwent colpocleisis with or without MUS from October 2007 to October 2017 was performed. Women with preoperative and 2-week postoperative post-void residual volume (PVR) measurements were included. Urinary retention was defined as PVR of ≥100 ml. Analysis included t tests/Wilcoxon rank, Chi-squared/Fisher's exact, and multivariate linear regression models. RESULTS A total of 231 women with a mean age of 77.7 years (± 6.0 years SD) met the inclusion criteria. One hundred and thirty-eight women underwent colpocleisis alone, whereas 93 women had colpocleisis with MUS. Preoperative retention rates were high (44.9% vs 34.4%, for colpocleisis alone versus with MUS, p = 0.114). Postoperative retention rates were lower and similar between the groups (10.1% vs 11.8%, for colpocleisis alone vs with MUS, p = 0.69). Linear regression models showed the adjusted odds ratio for postoperative urinary retention in patients with concomitant MUS was 1.68 (95% confidence interval: 0.64-4.41) compared with patients with colpocleisis alone and this did not reach statistical significance (p = 0.292). Fortunately, after colpocleisis, women had high rates of resolution of retention, regardless of MUS (80.3% vs 90.6% for colpocleisis alone vs with MUS; p = 0.20). Few women required reoperation for retention (3.1%). CONCLUSIONS Placement of an MUS at the time of colpocleisis is a safe and effective therapy. This appears to be unaffected by preoperative urinary retention status.
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Increasing Age Predicts Increasing Residual Urine Volume. Female Pelvic Med Reconstr Surg 2020; 26:769-773. [PMID: 30865030 DOI: 10.1097/spv.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine reference values for postvoid residual (PVR) volume for patients referred to a tertiary urogynecology center. METHODS After Institutional Review Board approval, we performed a retrospective chart review of all new patients presenting to our referral center. We assessed associations between PVR and patient demographics, pelvic floor symptoms, and physical examination by Wilcoxon rank sum or Kruskal-Wallis tests as appropriate. A multivariable logistic regression model was used to calculate odds ratios for patient characteristics associated with PVR in the top age range-specific decile. RESULTS Three hundred sixty-one patients were included in the analysis. The median PVR was 20 mL (interquartile range, 1st, 3rd quartiles, 10, 50). Older age was associated with higher PVR (P < 0.001). The median PVR in participants younger than 40 years was 10 mL, ages 40 to 49 years was 18 mL, 50 to 69 years was 20 mL, 70 to 79 years was 38 mL and in women older than 79 years was 50 mL. A multivariable analysis showed that prolapse stage (odds ratio [OR], 3.46 with prolapse stage 2-4 vs stage 0-1; P = 0.001), history of stroke (OR, 7.62; [95% CI 2.17-26.77, P = 0.002]), narcotic use (OR, 2.45; [95% CI 1.01-5.92; P = 0.047]), and urinary frequency (OR, 2.61; [95% CI, 1.14-5.98; P = 0.024]) were risk factors for increased PVR (as defined at >90%ile for age), independent of the age-related elevation. CONCLUSIONS The majority of patients presenting for urogynecologic evaluation had a low PVR with a median of 20 mL. Postvoid residual was higher for older age groups but nearly all volumes were less than 100 mL. The utility of a PVR measurement is highest for patients with pelvic organ prolapse, urinary frequency, narcotic use, or history of stroke.
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Burgio KL, James AS, LaCoursiere DY, Mueller ER, Newman DK, Low LK, Weinfurt KP, Wyman JF, Cunningham SD, Vargo K, Connett J, Williams BR. Views of Normal Bladder Function Among Women Experiencing Lower Urinary Tract Symptoms. Urology 2020; 150:103-109. [PMID: 32841655 DOI: 10.1016/j.urology.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the perspectives of normal bladder function among women with lower urinary tract symptoms. METHODS This was a secondary analysis of qualitative data from structured interviews with 50 adult women with lower urinary tract symptoms. A directed content analysis of the transcripts explored women's perspectives on normal bladder function. RESULTS Participants' descriptions of "normal" took many forms and were based on several aspects of bladder function. A prominent feature of normal was that voiding occurred as a seamless process, beginning with an urge sensation, followed by voiding with ease and to completion, and then "being done." Descriptions of normal were based largely on concepts of voiding regularity, including voiding frequency, intervals, and patterns during the day and night. Another aspect of normal bladder function was the notion of having control in terms of not leaking urine, as well as the ability to hold urine and defer urination. Views of normal bladder function extended to the absence of symptoms and the impact of being symptom-free on day-to-day life, including not having to think about or worry about the bladder or limit daily activities. CONCLUSION Women's perspectives on normal bladder function are multifaceted, reflecting attributes most salient to each individual and likely informed by their personal experience with symptoms and their influence on daily life. This work has implications for how clinicians might engage women in discussing bladder symptoms and can inform future research and public health messaging about normal bladder function.
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Affiliation(s)
- Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL.
| | - Aimee S James
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Diane K Newman
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Lisa Kane Low
- University of Michigan School of Nursing, Ann Arbor, MI
| | | | - Jean F Wyman
- University of Minnesota, School of Nursing, Minneapolis, MN
| | | | - Keith Vargo
- University of Minnesota School of Public Health, Minneapolis, MN
| | - John Connett
- University of Minnesota School of Public Health, Minneapolis, MN
| | - Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
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- National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
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Mengatto MF, Castro BGR, Nobrega L, Vieira MA, Andrade CEMC, Tsunoda AT, de Andrade DAP, Dos Reis R. Early removal of indwelling urinary catheter after radical surgery for early-stage cervical cancer-A cohort study. J Surg Oncol 2020; 122:1498-1505. [PMID: 32779228 DOI: 10.1002/jso.26167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the difference between early and delayed removal of indwelling urinary catheter after radical hysterectomy (RH) or radical trachelectomy (RT). METHODS An ambispective study was conducted in early-stage cervical cancer patients who underwent RH or RT. Delayed indwelling urinary catheter removal occurred on a postoperative day (POD) 7 in the retrospective group (January 2012-November 2013), and early removal occurred on POD 1 in the prospective group (May 2014-June 2017). The postvoid residual (PVR) test was performed after indwelling catheter removal in both groups. RESULTS Our sample included 47 patients in the delayed group and 48 in the early one. There was no difference in age, body mass index, tumor size, histology, stage, surgical approach, and intraoperative and postoperative complications. Indwelling urinary catheter reinsertion was needed in 16 (34%) patients in the delayed group and 12 (25%) in the early group (P = .37), with no statistical difference between the median PVR volumes -82.5 and 45 mL (P = .06), respectively. Seven (14.9%) patients in the delayed group presented with 30-day urinary tract infection vs two (4.2%) in the early group (P = .09). CONCLUSIONS Early indwelling urinary catheter removal, in regard to the rate of catheter reinsertion and PVR volume, does not differ from delayed removal.
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Affiliation(s)
- Mariana F Mengatto
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Beatriz G R Castro
- Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, Brazil
| | - Leandro Nobrega
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marcelo A Vieira
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Carlos E M C Andrade
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Audrey T Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Circadian Patterns in Postvoid Residual and Voided Percentage Among Older Women with Urinary Incontinence. J Clin Med 2020; 9:jcm9040922. [PMID: 32230885 PMCID: PMC7231299 DOI: 10.3390/jcm9040922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Women with urinary incontinence incur an increased risk of elevated postvoid residual (PVR) volume and impaired voiding efficiency (i.e., voided percentage (Void%)), but the clinical significance of these parameters remains poorly described. Further characterization of PVR and voiding efficiency may thus be useful in refining the evaluation and management of urinary incontinence. This study aims to explore possible circadian variations in PVR and Void% in older women with stress (SUI), urge (UUI) and mixed urinary incontinence (MUI). Methods: A single center prospective study which enrolled a convenience sample of 90 older women who consulted a tertiary referral hospital for urinary incontinence. Participants underwent an extensive medical interview and were hospitalized to complete a 24-h frequency-volume chart (FVC) with PVR measurement after each void (FVCPVR). Results: FVCPVR analysis demonstrated no differences in mean PVR and Void% between patients with SUI, UUI and MUI. Likewise, no daytime or nighttime differences were observed in mean PVR or Void% within or between groups. Conclusions: No evidence of circadian variation in PVR or Void% was observed in older women with SUI, UUI or MUI.
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11
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Hostetter O, Hemal K, Hines KN, Matthews CA. Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections? Int Urogynecol J 2019; 31:1209-1214. [PMID: 31832717 DOI: 10.1007/s00192-019-04198-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recurrent urinary tract infections (rUTIs) affect up to 44% of women; evidenced-based guidelines regarding the contributory role of a pelvic examination in these women are lacking. We hypothesize that routine pelvic examination has a limited role in evaluation and management of women with rUTI when appropriate symptoms-based screening is performed and normal post-void residual volume (PVR) is confirmed. METHODS We performed a retrospective chart review of women ages 18-85 years presenting to Wake Forest Pelvic Health Center with two culture-proven UTIs in 6 months or three UTIs in 12 months with a documented pelvic examination. Pregnant women were excluded. Data extraction included demographics, medical history, screening assessment of vaginal bulge symptoms, urine culture results, imaging, physical/pelvic examination findings, PVR, treatment recommendations and outcomes within 1 year of initial assessment. Descriptive statistics and Fisher's exact test were performed. RESULTS Of 160 charts screened, 91 met the inclusion criteria. Nineteen (21%) had symptoms of vaginal bulge, and 14 (17%) had PVR > 100 ml. Pelvic examination provided new/contributory information in eight (8.8%) of women. The negative predictive value of absence of bulge symptoms and normal PVR was 89%. Within 1 year, 41 (46%) reported symptom resolution with rUTI treatment with no difference between those with or without a contributory pelvic examination (p value = 0.64). CONCLUSIONS In women with rUTI who report absence of vaginal bulge symptoms and have a PVR < 100 ml, a pelvic examination provides contributory information in < 10% of women and did not change treatment outcomes.
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Affiliation(s)
- Olivia Hostetter
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Kshipra Hemal
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Katherine N Hines
- Department of Urology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC, 27101, USA
| | - Catherine A Matthews
- Department of Urology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC, 27101, USA.
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12
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Bakas P, Betta A, Papadakis E, Liapis E, Klimis N, Deligeoroglou E. Could the postoperative residual of urine predict the outcome of TVTOmidurethral sling procedure in female patients? Eur J Obstet Gynecol Reprod Biol 2019; 240:205-208. [PMID: 31325846 DOI: 10.1016/j.ejogrb.2019.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess if the amount of postoperative postvoid residual of urine that is within the normal range (less than 100 mls) could predict the outcome of TVTO (Tension -free vaginal tape obturator) procedure. STUDY DESIGN Second Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece. Patients that had been submitted to TVTO procedure between 2013 and 2017 were reviewed and outcome was assessed.The follow up assessment included cough stress test, the Patient Satisfaction Questionnaire (PSQ), the Urinary Distress Inventory-6 (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questionnaire. RESULTS The mean follow-up was 3.7 years (+1.35 years). Forty eight patients (40.3%) had only a TVTO procedure. Forty three patients (36.1%) had a TVTO procedure combined with anterior colporrhaphy. Twenty eight patients (23.6%) underwent a TVTO procedure and anterior colporrhaphy and posterior colpoperineorrhaphy. According to cough stress test 88% patients (105/119) were cured having a negative cough stress test. Using logistic regression analysis it was found that patient's age (p = 0.78), postoperative postvoid residual of urine ( = 0.24) or day of catheter removal (p = 0.22) had no statistically significant correlation with the medium term outcome of TVTO procedure. Also, regression analysis shows that patients' Body Mass Index (BMI) has negative correlation to the postoperative outcome. CONCLUSION(S) PVR < 50 mls appears to be related with successful medium term outcome after TVTO procedure. Also, patients' (BMI) has negative correlation to the postoperative outcome.
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Affiliation(s)
- P Bakas
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece.
| | - A Betta
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece
| | - E Papadakis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece
| | - E Liapis
- Mitera Maternity Hospital, Athens, Greece
| | - N Klimis
- Mitera Maternity Hospital, Athens, Greece
| | - E Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece
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13
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Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound. Int Urogynecol J 2019; 31:973-979. [PMID: 31309246 DOI: 10.1007/s00192-019-04045-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. METHODS Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). RESULTS Twenty women participated, with an average age of 27.95 ± 3.15 years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. CONCLUSIONS The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.
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Valdevenito JP, Flores J, Rojas RG, Manriquez V, Arribillaga L, de Benito J. Voiding symptoms obtained by open versus directed anamnesis as predictors of voiding dysfunction in women. Int Braz J Urol 2019; 45:798-806. [PMID: 31184452 PMCID: PMC6837622 DOI: 10.1590/s1677-5538.ibju.2018.0556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/23/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VS-Directed) to predict voiding dysfunction in women. Materials and Methods Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number five of the UDI-6 questionnaire (“Do you experience any difficulty emptying your bladder?”). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each o Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed. Conclusions VS-Open may predict better voiding dysfunction than VS-Directed in women.
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Affiliation(s)
- Juan Pablo Valdevenito
- Department of Urology, Urodynamics Unit, Hospital Clínico Universidad de Chile, Santiago, Chile.,Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - José Flores
- Department of Urology, Urodynamics Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Rodrigo Guzman Rojas
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Valentin Manriquez
- Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Juan de Benito
- Department of Urology, Instituto Modelo de Cardiología SRL, Córdoba, Argentina
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Affiliation(s)
- S. L. Johnston
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON, Canada
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Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 2018; 298:991-999. [PMID: 30191419 DOI: 10.1007/s00404-018-4875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To analyze major and minor complications following surgery for deeply infiltrating endometriosis including long-term impairment of intestinal, bladder, and sexual function. METHODS Patients who had undergone resection for deeply infiltrating endometriosis without anterior rectal resection between 2001 and 2011 were included (n = 134). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and to a healthy control group (n = 100). RESULTS Major complications occurred in 3.7% and minor complications in 12.7% of the patients. Surgical revision was necessary in five cases. The questionnaire response rate was 66.4%, with a mean follow-up period of 75.6 months. Weak urinary flow was reported by 26.4% of the patients; a feeling of residual urine by 16.1%; constipation by 13.5%; more than one bowel movement/day by 16.9%; insufficient lubrication during intercourse by 30.3%. The findings for weak urinary flow, feeling of residual urine, and insufficient lubrication differed significantly from the control group. Subgroup analysis did not identify any statistical associations between questionnaire responses and dyspareunia or dysmenorrhea as reasons for surgery, or previous endometriosis surgery in the patient's history. CONCLUSIONS The major and minor complication rates were consistent with or lower than the literature data. Few studies have investigated complication rates associated with treatment for endometriosis in the sacrouterine ligaments and/or the rectovaginal septum. The high rates of impaired bladder function and sexual function after endometriosis surgery, as well as inadequate data, make further prospective studies on this topic necessary.
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Into the void: a review of postoperative urinary retention after minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 30:260-266. [DOI: 10.1097/gco.0000000000000465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antonazzo P, di Bartolo I, Parisi F, Cetin I, Savasi VM. Preoperative and postoperative ultrasound assessment of stress urinary incontinence. ACTA ACUST UNITED AC 2018; 71:306-312. [PMID: 29952478 DOI: 10.23736/s0026-4784.18.04203-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The role of ultrasound imaging in urogynecology is not defined. Significant developments in visualization techniques and interpretation of images allowed to study structures of the lower genitourinary tract and pelvic floor. EVIDENCE ACQUISITION PubMed and Scopus database were searched for publications on the following item: stress urinary incontinence, ultrasound, perineal ultrasound and preoperative and postoperative assessment. EVIDENCE SYNTHESIS The role of ultrasound in urogynecology could be helpful in diagnosing of urinary incontinence and urethral hypermobility, to document pelvic floor anatomy and to assess anatomic and functional changes before and after surgery. CONCLUSIONS Ultrasound could be an important step during preoperative and post-operative assessment of patients affected by stress urinary incontinence.
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Affiliation(s)
- Patrizio Antonazzo
- Unit of Obstetrics and Gynecology, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Ilenia di Bartolo
- Unit of Obstetrics and Gynecology, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Parisi
- Unit of Obstetrics and Gynecology, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Valeria M Savasi
- Unit of Obstetrics and Gynecology, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy -
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Evaluation of intra-individual test-re-test variability of uroflowmetry in healthy women and women suffering from stress, urge, and mixed urinary incontinence. Int Urogynecol J 2018; 29:1523-1527. [PMID: 29478111 DOI: 10.1007/s00192-018-3571-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the intra-individual variability of uroflowmetry (UFM) in healthy control subjects and women suffering from stress, urge, and mixed urinary incontinence. METHODS A total of 35 healthy controls (group A) and 105 women suffering from urinary incontinence were enrolled in the study. Thirty-five women suffered from stress urinary incontinence (group B), 35 women suffered from mixed urinary incontinence (group C), and 35 women with overactive bladder both dry and wet (group D). All participants were asked to perform UFM measurement three times. The following parameters were analyzed: voided volume (VV), peak flow (Qmax), average flow (Qave), volume-corrected peak flow cQmax (cQmax = Qmax/2√ VV), volume-corrected average flow (cQave = Qave/2√ VV), and postvoid residual volume (PVR). Statistical analysis was performed using the analysis of variance on repeated measurements. Relative error was calculated using variation coefficients reported as a percentage of the average. All descriptive characteristics were reported as means ± standard deviation (SD). p values ≤0.05 were considered statistically significant. RESULTS No statistically significant intra-individual difference in any of the recorded parameters was identified among the three UFM recordings in groups A, C, and D. The intra-individual variability of the following parameters reached statistical significance in patients suffering from stress urinary incontinence (group B): Qmax (p = 0.0016), Qave (p = 0.0005), and cQave (p = 0.0389). A significant difference was only observed in comparison between the first and second consecutive recordings. CONCLUSIONS This study provides evidence supporting the high yield and good intra-individual reproducibility of UFM.
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Real-World Retention Rates After Intravesical OnabotulinumtoxinA for Idiopathic Overactive Bladder. Female Pelvic Med Reconstr Surg 2018; 24:404-407. [DOI: 10.1097/spv.0000000000000496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Pelvic floor disorders are common and cause significant morbidity for women. Recent advances in the evaluation of women with pelvic floor dysfunction have improved diagnostic accuracy and, with the development and use of validated patient-reported outcomes, has improved measurement of outcomes important to patients. We describe recent advances in the evaluation and measurement of pelvic floor disorders (PFDs). RECENT FINDINGS We describe recent developments in pelvic floor assessment of women with pelvic floor dysfunction. SUMMARY Complex integration of multiple anatomic structures and their function are necessary for pelvic floor function. Although the pillars of a complete assessment are a thorough history and physical exam, diagnostic tools can aid in fleshing out the correct and complete analysis of the patient suffering from PFDs.
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Renner SP, Kessler H, Topal N, Proske K, Adler W, Burghaus S, Haupt W, Beckmann MW, Lermann J. Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 2017; 295:1277-1285. [DOI: 10.1007/s00404-017-4360-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
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The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine. Female Pelvic Med Reconstr Surg 2017; 23:310-314. [DOI: 10.1097/spv.0000000000000390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ultrasound imaging in urogynecology - state of the art 2016. MENOPAUSE REVIEW 2016; 15:123-132. [PMID: 27980522 PMCID: PMC5137478 DOI: 10.5114/pm.2016.63060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 01/03/2023]
Abstract
The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.
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Miotla P, Cartwright R, Skorupska K, Bogusiewicz M, Markut-Miotla E, Futyma K, Rechberger T. Urinary retention in female OAB after intravesical Botox injection: who is really at risk? Int Urogynecol J 2016; 28:845-850. [PMID: 27889830 PMCID: PMC5437187 DOI: 10.1007/s00192-016-3212-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/08/2016] [Indexed: 12/25/2022]
Abstract
Introduction and hypothesis Intravesical onabotulinumtoxinA (Botox) injections are effective for the treatment of idiopathic overactive bladder (OAB) symptoms. The aim of our study was to assess the predisposing factors for urinary retention in women with OAB after intravesical Botox injection. Methods All participants were women of European descent with idiopathic OAB. OnabotulinumtoxinA (100 U) was administered in 20 intra-detrusor injections. Analysis was performed based on the results of safety assessments made during follow-up (FU) visits on weeks 2, 4 and 12, in 208 women who were treated with Botox injections for refractory OAB and who completed all FU visits. Results Women who required clean intermittent self-catheterisation (CISC) and those with post-void residual (PVR) greater than 200 ml were older in comparison with patients with PVR between 50 and 200 ml. Patients who required CISC were also characterised by higher parity and particularly by a higher number of vaginal deliveries. Other factors such as body mass index or comorbidities did not significantly influence PVR and the risk of CISC. Conclusions Elderly and/or multiparous women are at increased risk of urinary retention after intravesical 100-U Botox injections. The risk of new onset urine retention in our study has completely disappeared 2 weeks after Botox injections. Based on our results of the way in which the PVRs have changed over time, we can conclude that OAB patients should be optimally assessed during the first 2 weeks after Botox injections.
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Affiliation(s)
- Pawel Miotla
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Department of Urogynaecology, Imperial College London, London, UK
| | - Katarzyna Skorupska
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Michal Bogusiewicz
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Ewa Markut-Miotla
- Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Lublin, Poland
| | - Konrad Futyma
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
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Smith PP, Kuchel GA, Griffiths D. Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults. Clin Geriatr Med 2015; 31:549-65. [DOI: 10.1016/j.cger.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Smith PP, Kuchel GA. Clinical Meaning of a High Postvoid Residual: When the Value of a Result Is Less and More than One Would Expect. J Am Geriatr Soc 2015; 63:1432-4. [PMID: 26189846 DOI: 10.1111/jgs.13479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Phillip P Smith
- Division of Urology and Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - George A Kuchel
- Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Park J, Palmer MH. Factors Associated with Incomplete Bladder Emptying in Older Women with Overactive Bladder Symptoms. J Am Geriatr Soc 2015; 63:1426-31. [DOI: 10.1111/jgs.13474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jeongok Park
- College of Nursing; Yonsei University; Seodaemun-gu Seoul Korea
| | - Mary H. Palmer
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Caron F, Alexandre K, Pestel-Caron M, Chassagne P, Grise P, Etienne M. High bacterial titers in urine are predictive of abnormal postvoid residual urine in patients with urinary tract infection. Diagn Microbiol Infect Dis 2015; 83:63-7. [PMID: 26052063 DOI: 10.1016/j.diagmicrobio.2015.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/30/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
Urine bacterial titers (BTs) are influenced by bacterial and host factors. The impact of an abnormal postvoid residual (PVR) on BT in urine was investigated. A total of 103 inpatients with a urine growing Enterobacteriacae (≥ 10(2) CFU/mL) and a PVR measure were analyzed, mostly female (62%), elderly (mean age: 72 years), with urinary tract infection (25% of asymptomatic bacteriuria) due to Escherichia coli (85%). Fifty-two subjects (56%) had BT ≥ 10(6) CFU/mL; 48 (53%) had a PVR ≤ 100 mL, while 26 (25%) had a PVR >250 mL. PVR increased with BT, and a significant (P<0.0001) threshold was reached for 10(6) CFU/mL: 100mL mean PVR for patients with BT ≤ 10(5) CFU/mL versus 248 mL for patients with BT >10(5) CFU/mL. High PVR and BT were associated with complicated infections, concomitant bacteremia, and delayed apyrexia. Screening for patients with BT ≥ 10(6) CFU/mL is an easy way to identify patients at high risk for acute retention and voiding disorders.
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Affiliation(s)
- F Caron
- Infectious Diseases Department, Rouen University Hospital, GRAM (EA2656), Rouen, France
| | - K Alexandre
- Infectious Diseases Department, Rouen University Hospital, Rouen, France
| | - M Pestel-Caron
- Microbiology Department, Rouen University Hospital, GRAM (EA2656), Rouen, France
| | - P Chassagne
- Geriatrics Department, Rouen University Hospital, Rouen, France
| | - P Grise
- Urology Department, Rouen University Hospital, Rouen, France
| | - M Etienne
- Infectious Diseases Department, Rouen University Hospital, GRAM (EA2656), Rouen, France.
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Park J, Lavelle JP, Palmer MH. Voiding dysfunction in older women with overactive bladder symptoms: A comparison of urodynamic parameters between women with normal and elevated post-void residual urine. Neurourol Urodyn 2014; 35:95-9. [PMID: 25400112 DOI: 10.1002/nau.22689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/05/2014] [Indexed: 11/08/2022]
Abstract
AIMS To compare urodynamic parameters in two groups of older women who have overactive bladder (OAB) symptoms: those with normal and those with elevated post-void residual (PVR). METHODS Secondary data analyses were conducted on medical record data from 203 women who were 65 years or older and who completed urodynamic testing. Of these, 151 (74%) medical records met the study criteria. A PVR of 100 ml or greater during the pressure-flow study was considered elevated for this study. Maximal flow rate (Qmax ) and detrusor pressure at Qmax , bladder capacity, voiding volume, and voiding pattern were compared between these two groups. RESULTS The mean Qmax and detrusor pressure at Qmax were 19.63 ml/sec (SD = 8.74) and 16.15 cmH2 O (SD = 11.19) for the overall sample, respectively. The elevated PVR group (n = 54) had significantly higher detrusor pressure at Qmax and bladder capacity than the normal PVR group (n = 97) (P < 0.05, P < 0.01, respectively). An interrupted voiding pattern accounted for 47.4% of the normal PVR group and 77.4% of the elevated PVR group, respectively (P < 0.01). CONCLUSIONS Older women with an elevated PVR required on average a higher detrusor pressure at Qmax and greater bladder capacity than women with a normal PVR. Although an interrupted voiding pattern was more prevalent in the elevated PVR group, many women in the normal PVR group also had an interrupted voiding pattern. These findings indicate that many women may habitually strain to void as well as strain due to inadequate detrusor function.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Yonsei University, Seoul, Korea
| | - John P Lavelle
- Department of Urology, Stanford University, Stanford, California.,Director of Urodynamics, Voiding Dysfunction and Neuro-Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mary H Palmer
- School of Nursing, Interim Co-Director in Institute on Aging, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Espuña-Pons M, Cardozo L, Chapple C, Sievert KD, van Kerrebroeck P, Kirby MG. Overactive bladder symptoms and voiding dysfunction in neurologically normal women. Neurourol Urodyn 2012; 31:422-8. [PMID: 22419262 DOI: 10.1002/nau.21252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/21/2011] [Indexed: 01/23/2023]
Abstract
AIMS To understand mechanisms underlying overactive bladder (OAB) and voiding dysfunction (VD) in neurologically normal women. METHODS Review of MEDLINE from (1982) to (2011) using defined search terms, and manual analysis. Only articles published in English were included. RESULTS One in five women report moderate to severe lower urinary tract symptoms (LUTS). Whilst VD is more common in men, women report a higher rate of storage symptoms or post-micturition symptoms. Post-void residual (PVR) volume measurements are vital in the assessment of women with LUTS and patients with VD without stress incontinence (SUI) are likely to have an elevated PVR (82%). Bladder outlet obstruction (BOO) also causes VD in women and can be alleviated by surgery or alpha-blocker therapy, although OAB symptoms typically remain. Surgical repair for SUI can result in temporary VD in the minority of patients, highlighting the complex interplay that is emerging in the urethral bladder functioning complex in women. CONCLUSIONS Women with impaired bladder emptying present with a wide range of LUTS, and PVR measurement is essential for diagnosis. OAB and VD can clearly coexist and accurate diagnosis of underlying pathophysiology is required. Recommendations for clinical practice and research are provided including: investigation of VD in women with OAB; evaluation of PVR values to determine appropriate therapy and identification of BOO. There is clearly a need for further research into the impact of alpha-blockers in women with VD as well as an evaluation of PVR changes in women with OAB before and after antimuscarinic therapy.
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Affiliation(s)
- Montserrat Espuña-Pons
- Institut Clinic de Ginecologia, Obstetricia i Neonatologia Hospital Clinic, Universidad de Barcelona, Barcelona, Spain.
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Robinson D, Staskin D, Laterza RM, Koelbl H. Defining female voiding dysfunction: ICI-RS 2011. Neurourol Urodyn 2012; 31:313-6. [PMID: 22415792 DOI: 10.1002/nau.22213] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/12/2012] [Indexed: 11/12/2022]
Abstract
Whilst symptoms of bladder outlet obstruction (BOO) and post micturition symptoms are more commonly reported in men a significant number of women may also complain of voiding dysfunction. However, despite the recent advances in the standardisation of terminology of lower urinary tract dysfunction there remains a lack of consensus regarding a precise diagnosis and definition of voiding abnormalities in women. In addition voiding symptoms may co-exist with storage symptoms as well as those associated with urinary incontinence. Consequently many patients present with a spectrum of different urinary symptoms, related to both storage and voiding, which may be multifactorial in origin or be related to one another. The purpose of this paper is to review the current literature in order to accurately define and classify female voiding dysfunction including causes and aetiology. In addition to reviewing the investigation and management of those women with voiding dysfunction recommendations are proposed for management in clinical practice as well as suggestions for future research.
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Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, London, UK.
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Repeatability of post-void residual urine ≥ 100 ml in urogynaecologic patients. Int Urogynecol J 2011; 23:207-9. [DOI: 10.1007/s00192-011-1614-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022]
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Huang AJ, Brown JS, Boyko EJ, Moore EE, Scholes D, Walter LC, Lin F, Vittinghoff E, Fihn SD. Clinical significance of postvoid residual volume in older ambulatory women. J Am Geriatr Soc 2011; 59:1452-8. [PMID: 21806559 DOI: 10.1111/j.1532-5415.2011.03511.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the prevalence, natural history, and clinical significance of high postvoid residual (PVR) volume in ambulatory older women. DESIGN Prospective cohort study. SETTING Group health plan in Washington state. PARTICIPANTS Nine hundred eighty-seven ambulatory women aged 55 to 75. MEASUREMENTS PVR was measured using bladder ultrasonography at baseline, 1 year, and 2 years. Participants completed questionnaires about urinary symptoms and provided urine samples for microbiological evaluation. RESULTS Of the 987 participants, 79% had a PVR less than 50 mL, 10% of 50 to 99 mL, 6% of 100 to 199 mL, and 5% of 200 mL or greater at baseline. Of women with a PVR less than 50 mL, 66% reported at least one urinary symptom at baseline. Of women with a PVR of 200 mL or greater, 27% reported no significant symptoms at baseline. In adjusted analyses using data from all study visits, women with a PVR of 100 mL or greater were more likely to report urinating more than eight times during the day (odds ratio (OR)=1.42, 95% confidence interval (CI)=1.07-1.87), and women with a PVR of 200 mL or greater were more likely to report weekly urgency incontinence (OR=1.50, 95% CI=1.03-2.18) than those with a PVR less than 50 mL. High PVR was not associated with greater risk of stress incontinence, nocturnal frequency, or urinary tract infection in adjusted analyses. Forty-six percent of those with a PVR of 200 mL or greater and 63% of those with a PVR of 100 to 199 mL at baseline had a PVR less than 50 mL at 2 years. CONCLUSION More than 10% of ambulatory older women may have a PVR of 100 mL or greater, which is associated with greater risk of some urinary symptoms, but many with high PVR are asymptomatic, and high PVR frequently resolves within 2 years. Symptom-guided management of urinary symptoms may be more appropriate than PVR-guided management in this population.
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Affiliation(s)
- Alison J Huang
- Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
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Ultrasound measurement of bladder wall thickness in different forms of detrusor overactivity. Int Urogynecol J 2010; 21:1405-11. [DOI: 10.1007/s00192-010-1194-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 05/27/2010] [Indexed: 01/04/2023]
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DuBeau CE, Kuchel GA, Johnson II T, Palmer MH, Wagg A. Incontinence in the frail elderly: Report from the 4th international consultation on incontinence. Neurourol Urodyn 2010; 29:165-78. [DOI: 10.1002/nau.20842] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pace G, Silvestri V, Gualá L, Vicentini C. Body mass index, urinary incontinence, and female sexual dysfunction. Menopause 2009; 16:1188-92. [DOI: 10.1097/gme.0b013e3181a6b491] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The understanding of voiding dysfunction has been greatly assisted by the current introduction of clear definitions for its diagnosis and for the abnormalities of urine flow rates and postvoid residuals that are its basis. Its prevalence in women with symptoms of pelvic floor dysfunction is up to 40%. Most of the recent research has centered on the associations of voiding dysfunction with age, pelvic organ prolapse, and prior continence surgery. The effects of parity, medications, and pelvic tumors have also been explored.
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Affiliation(s)
- Bernard T Haylen
- University of New South Wales and St. Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst 2010, New South Wales, Australia.
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Immediate postvoid residual volumes in women with symptoms of pelvic floor dysfunction. Obstet Gynecol 2008; 111:1305-12. [PMID: 18515513 DOI: 10.1097/aog.0b013e31817615b2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the prevalence and clinical and urodynamic associations of postvoid residual volumes (PVRs), measured immediately after micturition, in women with symptoms of pelvic floor dysfunction. METHODS The patients were 1,140 women presenting consecutively for their initial urogynecological assessment, including urodynamics. They were studied prospectively. Measurement of PVRs was by transvaginal ultrasonography within 60 seconds of micturition. After the estimation of prevalence of the different levels of PVR, an appropriate upper limit of normal PVR was estimated and associations then were sought for PVRs with a wide range of clinical and urodynamic parameters. RESULTS The overall prevalence of PVRs was 76% at 0-10 mL, 5% at 11-30 mL, 5% at 31-50 mL, 8% at 51-100 mL, and 6% at more than 100 mL. Thus, using transvaginal ultrasonography, 81% of immediate PVRs were 30 mL or less. Higher than 30 mL, a significantly increased prevalence of women presenting with recurrent urinary tract infections (UTIs) was noted (P<.001). The level of 30 mL was deemed to be an appropriate upper limit of normal PVR. The prevalence of PVRs higher than 30 mL increased significantly with age (P<.001) and higher grades of prolapse (P<.001). There was a significant inverse relation of PVRs higher than 30 mL to the symptom of stress incontinence (P=.018) and the diagnosis of urodynamic stress incontinence (P<.001). CONCLUSION Eighty-one percent of immediate PVRs (95% confidence interval 79-84%) in symptomatic women are 30 mL or less. Postvoid residual volumes higher than this level are significantly associated with increasing age, higher grades of prolapse, and an increased prevalence of recurrent UTIs. LEVEL OF EVIDENCE II.
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Haylen BT, Lee J. The accuracy of post-void residual measurement in women. Int Urogynecol J 2008; 19:603-6. [PMID: 18301853 DOI: 10.1007/s00192-008-0568-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 01/06/2008] [Indexed: 02/01/2023]
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