Post void bladder volume normal series#
Coombes and Millard 4 compared the BladderScan™ BVI 2500 series (Diagnostic Ultrasound, Bothell, Wash) with catheterization for the measurement of bladder volume.
Post void bladder volume normal portable#
Portable 3-dimensional ultrasound devices have been shown to provide highly accurate measurement of bladder volume. In contrast, bladder ultrasound can be performed with a portable device, is noninvasive and time-efficient, minimizes medical waste and supplies, and determines when catheterization is medically appropriate however, no urine specimen is obtained during this procedure. Although sterile catheterization provides a urine sample, there are many disadvantages associated with the procedure: it causes patient discomfort, carries a risk of urethral trauma and UTI, is time-consuming, and may not be necessary. There are 2 methods of measuring PVR: sterile catheterization and bladder ultrasound. Poor bladder contractility can result from neurogenic, myogenic, psychogenic, or pharmacologic causes. BOO can stem from prostatic enlargement, poor sphincter relaxation (dyssynergia), urethral or meatal blockage, or less common causes, such as a bladder stone. High PVRs can be caused by BOO, bladder hypocontractility or acontractility or, in rare cases, a large bladder diverticulum ( Figure 4). Very large PVRs (>300 mL) may be associated with an increased risk of upper urinary tract dilation and renal insufficiency. Large PVRs are associated with UTIs, especially in persons at risk, such as children or patients with spinal cord injury or diabetes. However, most urologists agree that volumes of 50 mL to 100 mL constitute the lower threshold defining abnormal residual urine volume. Threshold values delineating what constitutes an abnormal PVR are poorly defined. Like uroflowmetry, PVR measurement helps to identify patients in need of further evaluation and to evaluate treatment effect during follow-up. Measurement of postvoid residual urine volume (PVR), the amount of residual urine in the bladder after a voluntary void, is another noninvasive screening test for evaluating voiding dysfunction. The strength of uroflow is in helping to identify patients who need further urodynamic studies to diagnose an underlying problem. 3 In fact, uroflowmetry alone is insufficient to diagnose BOO, because it cannot distinguish true obstruction from poor bladder contractility. The Siroky nomogram is the most widely used in the United States today, but its specificity and sensitivity in diagnosing BOO are mixed (30% and 91%, respectively). A more precise diagnosis can be achieved with a pressure-flow study, a component of urodynamics.īecause uroflow is partly dependent on volume voided, uroflowmetry nomograms, such as the Siroky, the Bristol, the Liverpool, and the Balslev-Jorgensen nomograms, are useful in distinguishing normal from abnormal flow rates. Differentiating between patterns A and B can be challenging. Voided volumes should be greater than 150 mL volumes less than 150 mL can result in misinterpretation. Typical uroflow patterns of common voiding disorders: (A) obstructive, or “breadloaf,” pattern (B) detrusor impairment pattern (C) Valsalva voiding pattern and (D) superflow pattern. When considering a prostate-specific antigen measurement, the clinician should take into account the patient’s age, life expectancy, and intent to treat. Additional tests include urinary cytology to screen for carcinoma in situ of the urothelium. Laboratory tests considered standard by most guidelines are urinalysis and serum creatinine measurement, which can be used to assess for urinary tract infections (UTIs) and renal function, respectively. The evaluation of a patient with LUTS consists of a detailed medical history taking administration of a patient-driven questionnaire, such as the American Urological Association Symptom Index and a genitourinary examination, including a pelvic examination in women or a digital rectal examination in men. It is not uncommon for abnormalities of the voiding phase to cause problems in the storage phase, for example, the occurrence of bladder overactivity with bladder outlet obstruction (BOO). When evaluating patients with lower urinary tract symptoms (LUTS), it is often helpful for clinicians to characterize the potential urinary problem as a storage disorder, voiding disorder, or a combination of both.
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