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

Abstract

A retrospective case-control study was designed to assess risks for elevated post void residual (PVR) in women with pelvic floor disorders. The 1,399 women underwent evaluation including standardized questionnaire, examination, and catheterized PVR. Elevated PVR was defined as > or =100 ml and anterior and apical prolapse was defined as at or beyond the hymen. Overall, the prevalence of elevated PVR was 11%. After matching, the absence of stress incontinence symptoms (OR 0.55, CI 0.33-0.92), the symptoms of vaginal bulge (OR 2.19, CI 1.38-3.48), pelvic pressure (OR 1.79, CI 1.14-2.86), urinary splinting (OR 2.89, CI 1.24-6.74), and presence of prolapse (OR 2.60 CI 1.62-4.18) were significantly associated with an elevated PVR. Only prolapse (OR 1.96 CI 1.37-2.79) maintained a significant association after multivariate analysis. Symptoms alone do not predict which women may have an elevated PVR, but the finding of prolapse at or beyond the hymen is associated with incomplete emptying. Elevated post void residuals cannot be predicted based on symptoms alone; however, prolapse beyond the hymen may help identify women with incomplete bladder emptying.

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

“…Our results confirmed previous data which demonstrated that advanced prolapse and aging are independent predictors for urinary retention [5,7,9]. In a previous study done by Groutz et al, the prevalence of voiding dysfunction was higher among elderly patients [7].…”

“…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.…”

“…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. Unlike in a previous study [9], we thought that if we selected women who reported greater bother from obstructive voiding symptoms, we may be better able to identify women with urinary retention and increase the sensitivity of the specific queries. However, even in women with significant bother from obstructive voiding symptoms, the sensitivity and specificity of validated voiding questions remained low.…”

“…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].…”

The accuracy of post-void residual measurement in women

“…PVR measurement methodology has considerable variation [3][4][5][6] matched by similar variation in the results of scientific studies on this parameter [3][4][5][6][7]. In many other PVR studies, the exact methodology is either unclear or not validated or both.…”