Average Postvoid Residual Volume Research Articles

Prevalence of Bladder Dysfunction in Acute Decompensated Heart Failure

Background The primary therapeutic objective during the treatment of acute decompensated heart failure (ADHF) is relief from volume overload. This is achieved primarily through urinary losses of sodium and water from diuretics. Urine output is a primary source of data for monitoring and titrating therapy in these patients. To our knowledge, the prevalence and natural history of bladder dysfunction in patients with ADHF undergoing diuresis has not been described. Hypothesis Bladder dysfunction will be common among patients with ADHF. Methods Patients admitted to Yale New Haven hospital with worsening heart failure requiring IV diuresis were prospectively enrolled. After a forced void, bladder ultrasounds were conducted using a Verathon® BVI 3000 bladder scanner. Three values were taken for each patient and averaged. In a subset of these patients, an ambulatory outpatient follow-up bladder scan was performed. Results 283 patients were enrolled and underwent determination of post void residual (PVR) volume. The average PVR volume was 131 ± 169 ml. Only 41% of patients had a normal PVR ( 100 ml and 23% of the patients had a PVR greater than 200 ml, which meets criteria for acute urinary retention. Surprisingly, we did not find a significant difference in the PVR retention volume between men (138 ± 166 ml) and women (118 ± 173 ml; p=0.32). There was also no difference in the prevalence of a PVR greater than 200 ml between men and women (p=0.19). Similarly, age and diabetic status were not correlated with PVR (p=NS for both) and in patients with a PVR >200 ml both the age (65 ± 15 years vs. 64 ± 13 years, p=0.62) and odds of having diabetes (OR=1.1, p=0.78) were not different. A total of 106 patients returned for an ambulatory a median of 43 days after discharge and had a repeat determination of PVR. Notably, there was a significant improvement in PVR volume post discharge with a mean 58 ± 134 ml (p 200 ml while hospitalized but only 4.7% had a PVR>200 ml at the return visit. Conclusion Significant bladder dysfunction is highly prevalent in ADHF patients and was not associated with traditional causes for bladder dysfunction. This dysfunction was largely resolved upon outpatient follow-up. Additional research is needed to understand the cause and clinical implications of the high rate of bladder dysfunction in patients with ADHF.

Does Post-Void Residual Volume Predict Worsening Urological Symptoms in Patients with Multiple Sclerosis?

Our goal was to examine how post-void residual urine volume relates to urinary symptoms in patients with multiple sclerosis. We retrospectively reviewed the records of patients with multiple sclerosis who had lower urinary tract symptoms and presented to a tertiary neurourology clinic. Patients for whom post-void residual volume was recorded at the initial urological assessment were included in our analysis. Results of the AUA (American Urological Association) SI (Symptom Index) and the M-ISI (Michigan Incontinence Symptom Index) completed at this visit were analyzed to assess the severity of lower urinary tract symptoms and incontinence. A chart review was performed to obtain information on demographics and documented urinary tract infections. Between 2014 and 2017, 110 patients diagnosed with multiple sclerosis underwent post-void residual volume measurement at our clinic. Average post-void residual volume was 123.4 cc (range 0 to 650 cc). The mean AUA symptom score was 19.1 with an average bother score of 4.1. Analysis of post-void residual volume as a continuous variable did not show an association between increasing post-void residual volume and an increasing AUA SI or bother score (p= 0.53 and 0.44, respectively). When evaluated by post-void residual volume tertile, no relationship was found between post-void residual volume, and the AUA SI and the M-ISI (p = 0.54 and 0.57, respectively). No correlation was also found between increasing post-void residual volume and a recent history of recurrent urinary tract infections (p = 0.27). Post-void residual volume was not associated with worsening obstructive lower urinary tract symptoms as assessed by the AUA SI, worsening incontinence as measured by the M-ISI score or an increased risk of recurrent urinary tract infections in select patients with multiple sclerosis and lower urinary tract symptoms.

Critical reviews of 1470-nm laser vaporization on benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is recognized as the common chronic disease that affect majority of men in their elder ages. Nevertheless, there are no effective documents for BPH treatment. Even though great progression has been made on BPH by laser surgery, it also faces several challenges. In this study, our aims were to explore the effects of 1470-nm laser vaporization on BPH. For the research, a total of 170 BPH patients were enrolled. A 1470-nm laser vaporization apparatus was purchased for the surgery. The indicators such as serum sodium, international prostate symptom score (IPSS), Quality of life (QOL), maximum flow rate (Qmax), prostate specific antigen (PSA), and average Post-void Residual Volume (PVR) were detected for evaluating the prostate function. The operation was successful in all 170 patients, neither of whom converted to transurethral resection of the prostate (TURP) nor to open surgery. The surgery time was 52.3±5.6min, the laser emission time was 35.6±3.2min, the energy consumption was 254.1±19.3kJ. The level of serum sodium showed no significant difference between the pre- and post-operation. Qmax was significantly increased in post-operation, while IPSS, QOL, PVR, and PSA were significantly decreased in the post-operation. The 1470-nm laser vaporization treatment protected patients against BPH, indicating that 1470-nm laser vaporization might be important on treating BPH, which provided solid foundation for further clinical treatment.

La néovessie iléale en W : résultats fonctionnels et qualité de vie à long terme

To evaluate functional outcomes and patients' health-related quality of life over ten years after a W-shaped ileal neobladder urinary diversion. From 1994 to 2004, 87 patients with bladder cancer underwent a cystoprostatectomy with a W-shaped ileal neobladder. Among them, 31 patients (35.6%) were evaluated. The average follow-up was 158months, average age was 72years. We assessed functional outcomes (use of protections, USP score, uroflowmetry, postvoid residual volume), overall health-related quality of life (SF-36 score), and specific urinary-related quality of life (Ditrovie scale). Daytime continence was satisfactory in 29 patients (96.8%). Night-time continence was satisfactory in 27 patients (87.1%). Mean daytime continence, hyperactivity and dysuria scores of the USP were respectively 1.5/9, 3.2/21 and 2/9. Mean value of the maximum flow rate was 18mL/s for an average voiding volume of 324mL and an average postvoid residual volume of 70mL. The 8 dimensions of the SF-36 were all comparable with the French population's values. According to the Ditrovie scale whose average value was 1.83, the health-related quality of life was unchanged or little changed by urinary disorders in 28 patients (90.3%). Our results suggest that voiding status and health-related quality of life remain satisfactory over ten years after an orthotopic ileal neobladder derivation. 5.

Preperitoneal Single-port Transvesical Enucleation of the Prostate (STEP) for Large-volume BPH: One-year Follow-up of Qmax, IPSS, and QoL

To evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH). Nine patients with moderate- to large-volume (83.8 ± 19.9 mL) BPH (mean age 71.9 ± 6.39 years, body mass index [BMI] 21.5 ± 3.25 kg/m(2)) were preoperatively evaluated by abdominal and transrectal ultrasonography, uroflowmetry, International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL). The STEP procedures were performed by a single surgeon. All patients were followed up for a minimum of 12 months postoperatively by ultrasonography, uroflowmetry, IPSS, and QoL. STEP was smoothly completed in 8 cases with 1 case of open conversion owing to failure of the single-port device insertion. The mean operative duration was 160.9 ± 30.24 minutes, and the estimated blood loss was 418.8 ± 282.76 mL. One intraoperative complication of bleeding occurred. Postoperative complications occurred for 2 patients, including one case each of acute epididymitis and urethral stricture. At the 12-month follow-up after surgery, the mean Q(max) of the entire cohort was 22.7 ± 4.62 mL/s (an increase of 12.9 mL/s), with an average postvoid residual volume of 36.1 ± 40.02 mL, an IPSS of 4.1 ± 1.36 (a decrease of 21 points), and a QoL of 1.4 ± 1.19 (a decrease of 3.2 points). No patients developed incontinence or bladder neck contracture. In selected patients with voluminous BPH, STEP is a safe, feasible, and efficacious procedure with a promising outcome at 1-year follow-up in terms of Q(max), IPSS, and QoL.