Do subjective symptoms of obstructive voiding correlate with post-void residual urine volume in women?

Abstract

The objective was to determine if symptoms of obstructive voiding correlate with post-void residual urine volume measured by catheterization. A cross-sectional study of 134 consecutive women referred to a tertiary urogynecology clinic was performed. Subjects were interviewed regarding three types of obstructive voiding symptoms: a sensation of incomplete emptying, straining to void, and slow urine stream. Post-void residual urine volume was measured by catheterization as the gold standard. Data for each symptom were analyzed using Cohen's kappa test, sensitivity, specificity, likelihood ratios for a positive of negative test, and positive and negative predictive values. A total of 11 out of 134 patients (8%) had a post-void residual volume greater than 100 ml. Of these 11, 1 had symptoms of incomplete emptying (9%), 1 had symptoms of straining to void (9%), and 2 had symptoms of slow urine stream (18%). Sensitivity, specificity, likelihood ratio for a positive symptom, likelihood ratio for a negative symptom, positive predictive value, negative predictive value, and Cohen's kappa, respectively, were 9%, 80%, 0.47, 1.13, 4%, 91%, and 0.05 for the symptom of incomplete emptying, 9%, 91%, 1.12, 1.0, 8%, 92%, and 0.01 for straining to void, and 18%, 89%, 1.6, 0.92, 13%, 92%, and 0.07 for the symptom of slow urine stream. It was concluded that symptoms of obstructive voiding do not correlate with measured post-void urine volume. In clinically important situations, these symptoms cannot substitute for measurement of post-void residual urine volume.

Obstructive voiding symptoms are not predictive of elevated postvoid residual urine volumes

“…Although obstructive voiding symptoms were commonly reported in this population, these symptoms did not reflect the actual rates of urinary retention. Our data is consistent with previous investigators who also found a poor correlation between obstructive voiding symptoms and urinary retention in women [8,9]. Before this study, we hypothesized that women with higher PVR will have more prominent obstructive symptoms; therefore, we arbitrarily chose the volume of 150 ml rather than 100 ml as the cutoff for urinary retention.…”

“…Unfortunately, the relationship between symptoms of obstructive voiding in women and elevated PVR and bladder outlet obstruction is unclear. Previous studies present conflicting results when investigating the utility of different subjective measures of voiding dysfunction as they relate to patients' objective symptoms [2,[5][6][7][8][9].…”

Elevated postvoid residual in women with pelvic floor disorders: prevalence and associated risk factors

“…Our group included all women seeking care in a female pelvic medicine clinic and not only those women with urge or mixed incontinence. Recently, Al-Shahrani and Lovatsis [8] reported on the predictive value of obstructive voiding symptoms and showed a poor relationship between symptoms of incomplete emptying, straining, and poor flow in a group of 134 women presenting to their Urogynecology unit. Our data support this lack of relationship; however, the symptom of splinting to void, which was significant on our univariate analysis, was not assessed in these patients.…”

The Evolution of Surgical Treatment for Female Stress Urinary Incontinence: Era of Mid-Urethral Slings

“…The presence of exaggerated urethral or urethrovesical junction angulation with a high, fixed urethra located in the retro pubic area is suggestive of urethral hypercorrection [57]. Although there is no established cutoff between normal and abnormal PVR, and no evidence of correlation between PVR and symptoms of obstructive voiding, PVR of more than 100 ml is considered abnormal in women [58-60]. Blaivas and Groutz proposed an obstruction nomogram for women on the basis of free maximal flow rate and maximal detrusor pressure during pressure-flow study [61].…”