Elevated Postvoid Residual Urine Volume Research Articles

Efficacy and safety of onabotulinumtoxinA in patients with overactive bladder: subgroup analyses by sex and by serum prostate-specific antigen levels in men from a randomized controlled trial

PurposeWe aimed to assess onabotulinumtoxinA treatment outcomes by sex in patients with overactive bladder (OAB) and then explore the impact of serum prostate-specific antigen (PSA) levels in men.MethodsPatients inadequately managed with OAB medications were randomized to receive single-dose onabotulinumtoxinA (100 U) or placebo intravesical injection in a phase III trial in Japan. We performed subgroup analyses by sex and post-hoc subgroup analyses using male PSA categories.ResultsIn women (n = 186), onabotulinumtoxinA demonstrated statistically significant and clinically relevant improvements in all urinary symptoms at Week 12. In men with lower PSA (< 1.5 ng/mL, n = 40), onabotulinumtoxinA also showed numerically greater reductions in urinary symptom frequency than placebo; the between-group differences (onabotulinumtoxinA minus placebo) in change from baseline in the average daily number at Week 12 for urinary incontinence (UI), urgency UI, micturition, urgency, and nocturia were − 1.43, − 1.79, − 2.81, − 2.45, and − 0.32 episodes, respectively. In men with higher PSA (≥ 1.5 ng/mL, n = 22), onabotulinumtoxinA did not reduce urinary symptom frequency. Some patients treated with onabotulinumtoxinA showed elevated post-void residual urine volume at Week 2 (≥ 200 mL): 4 of 91 women, none of the men with lower PSA and 3 of 11 men with higher PSA.ConclusionsOnabotulinumtoxinA was efficacious and well tolerated in women and in men with lower PSA levels. Given our post-hoc subgroup analyses which suggested that onabotulinumtoxinA treatment is a good treatment option for OAB males with lower PSA levels, future studies having prostate volume data with larger sample size are warranted to verify our findings.ClinicalTrials.gov IdentifierNCT02820844 (first posted July 1, 2016). https://clinicaltrials.gov/ct2/show/NCT02820844.

Elevated Postvoid Residual Urine Volume: Identifying Risk Factors and Predicting Resolution in Women With Pelvic Organ Prolapse

(Abstracted from Female Pelvic Med Reconstr Surg 2018;24:444–448) No definition of what constitutes normal postvoid residual (PVR) is universally accepted. However, a commonly used definition is a PVR less than 100 mL.

A new approach to laparoscopic implantation of artificial urinary sphincter: Vesicovaginal approach to the bladder neck

IntroductionThe artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck. Material and methodsWe present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalized through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection. ResultsSurgery time: 140 and 135min, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent. ConclusionsWe present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.

Elevated Postvoid Residual Urine Volume: Identifying Risk Factors and Predicting Resolution in Women With Pelvic Organ Prolapse.

This study aims to identify risk factors for elevated preoperative postvoid residual (PVR) and persistently elevated postoperative PVR and to evaluate the resolution rate of elevated PVR urine volume in patients undergoing reconstructive surgery for pelvic organ prolapse (POP). This was a retrospective cohort study comparing 50 women with elevated preoperative PVR (≥100 mL) and 50 women with normal PVR (<100 mL). Preoperative demographic, physical examination, urodynamic data, type of surgery performed, and postoperative trial of void data were collected. Variables were evaluated for association with elevated PVR using Student t test or Mann-Whitney U test, and χ or Fisher exact test. The elevated PVR cohort was older (65.5 ± 13.3 vs 60.6 ± 10.1 years, P = 0.04). The cohorts did not differ by body mass index, parity, number of cesarean deliveries, prior hysterectomy, incontinence, prolapse surgery, menopausal status, hormone replacement therapy, history of recurrent urinary tract infections, diabetes mellitus, or maximum bladder capacity. Most patients had preoperative anterior prolapse stage 2 or 3. Complaints of incontinence, incomplete bladder emptying, and overactive bladder did not differ between groups. Performed Surgical procedures, cystoscopy findings, and rate of postoperative trial of void failures did not differ between groups. One patient per cohort learned clean intermittent self-catheterization for persistently elevated PVR. All women undergoing surgery for POP had postoperative resolution of elevated PVR. Patients with nonneurogenic-elevated PVR can be reassured that bladder emptying will improve after surgical repair of POP.

Nueva aproximación al implante laparoscópico del esfínter urinario artificial: abordaje vesicovaginal al cuello vesical

IntroductionThe artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck. Material and methodsWe present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection. ResultsSurgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent. ConclusionsWe present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.

135 - Elevated Post-Void Residual Urine Volume: Identifying Risk Factors and Predicting Resolution

Study Objective: Evaluate the resolution rate of elevated post-void residual urine volume (PVR) in patients undergoing reconstructive surgery for pelvic organ prolapse (POP), and identify risk factors for elevated preoperative PVR and persistently elevated postoperative PVR.

Falsely Elevated Postvoid Residual Urine Volume in Uterine Myoma.

Precise measurement of postvoid residual (PVR) urine volume is a key factor in assessing patients with voiding dysfunction, including those with lower urinary tract problems. The safe and noninvasive ultrasound bladder scan is the preferred mode to measure PVR volume. However, this procedure has a false-positive rate up to 9%, in the presence of ovarian cysts, renal cysts, ascites, or uterine myoma with cystic degeneration. Until now, cystic lesions are known to cause false positivity in ultrasound bladder scanner. However, we encountered falsely-elevated PVR in two cases of non-cystic uterine myomas. We present these cases with detailed radiologic images and volume measurement data.

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children

The aim of this study was to examine whether toilet-trained children with a history of febrile urinary tract infection (fUTI) and elevated postvoid residual (PVR) urine volume according to a recently published PVR nomogram were at greater risk of UTI recurrence. One month after recovery from febrile UTI, constipation was diagnosed according to the Rome III criteria, and lower urinary tract (LUT) function was evaluated with two sets of uroflowmetry and PVR by ultrasonography. For children aged ≦ 6 and ≧ 7 years, elevated PVR is defined as >20 and >10 ml, respectively. Cox proportion hazards regression was used to evaluate the risk factors for recurrence of UTI. Between 2005 and 2011, 60 children aged 6.5 ± 2.5 years (boy:girl ratio 27:33) were enrolled for analysis. Univariate analysis showed that recurrent febrile UTI was more commonly observed in children with elevated PVR [repetitive elevated PVR: hazard ratio (HR) 5.75, 95% confidence interval (CI) 1.41-23.4; one elevated PVR: HR 4.53, 95% CI 1.01-20.2] and high-grade vesicoureteral reflux (VUR; HR 4.53, 95% CI 1.46-14.07). Multivariate analysis showed that younger age (HR 1.37, 95% CI 1.03-1.82, p < 0.01) and elevated PVR (HR 2.88, 95% CI 1.44-5.73, p = 0.01) were significant, independent risk factors for recurrent febrile UTI--but not gender, presence of high-grade VUR and constipation. Elevated PVR defined by the new PVR nomogram predicted recurrent UTI in children with history of febrile UTI. Care should be taken to manage children with elevated PVR.

Predictive value of obstructive voiding symptoms and objective bladder emptying tests for urinary retention

The prevalence of voiding dysfunction was 47.4% by the question of “do you usually experience a feeling of incomplete bladder emptying” from Korean version of PFDI (pelvic floor distress inventory), 33.7% by the value of less than 10th centile of peak flow rate of uroflowmetry by Liverpool nomogram, 20.2% by the cutoff values of less than 12 ml per second of maximum flow rate and greater than 25cmH20 of detrusor pressure at maximum flow rate in the pressure flow study and 11.6% by the elevated post-void residual urine volume more than 50 ml in 95 women who visited urogynaecology clinic with lower urinary tract symptoms. Each method had low positive predictive values for high post-void residuals (subjective symptom 0.16, uroflowmetry 0.29, pressure flow study 0.28). The prevalence of voiding dysfunction is fairly high and none of the questionnaire and objective bladder emptying tests is sufficient for the diagnosis of urinary retention.

Sacral Nerve Stimulation for Treatment of Refractory Urinary Retention: Long-Term Efficacy and Durability

To examine the long-term efficacy and durability of sacral nerve stimulation (SNS) for the treatment of refractory, nonobstructive urinary retention. A retrospective study of all patients who underwent SNS with the InterStim device for refractory, nonobstructive urinary retention was performed. All patients had their history taken, underwent physical examination and urodynamic study, and completed a voiding diary before treatment with staged SNS. Patients with greater than 50% improvement in symptoms underwent implantable program device placement. Patients were followed up for evidence of postoperative complications, device failure, and treatment efficacy. Statistical analyses were performed. From June 1, 2000 to February 1, 2007, 40 patients were treated with SNS for refractory, nonobstructive urinary retention. Of the 40 patients, 29 had complete urinary retention (using clean intermittent catheterization), and 11 demonstrated incomplete retention (elevated postvoid residual urine volume). Of the 40 patients, 28 (70%) demonstrated greater than 50% improvement in symptoms and underwent implantable program device placement. At a mean follow-up of 40.03 +/- 19.61 months, 24 (85.7%) of 28 patients demonstrated sustained improvement of greater than 50%. Of the 28 patients, 4 (14.3%) had their InterStim device removed and 6 (21.4%) required revision. Among those with complete retention, significant improvement occurred in the number of catheterizations/day and the volume/catheterization (P <0.001). Among those with incomplete retention, significant improvement occurred in the postvoid residual urine volume (P <0.001). At a mean follow-up of 40 months, 85.7% of patients with refractory, nonobstructive urinary retention demonstrated greater than 50% improvement in symptoms with SNS. For 911 patients, a statistically significant improvement in voiding parameters resulted.

Accuracy and precision of a new portable ultrasound scanner, the BME-150A, in residual urine volume measurement: a comparison with the BladderScan BVI 3000

The objective of the study was to determine the relative accuracy of a new portable ultrasound unit, BME-150A, and the BladderScan BVI 3000, as assessed in comparison with the catheterized residual urine volume. We used both of these machines to prospectively measure the residual urine volumes of 89 patients (40 men and 49 women) who were undergoing urodynamic studies. The ultrasound measurements were compared with the post-scan bladder volumes obtained by catheterization in the same patients. The ultrasounds were followed immediately (within 5 min) by in-and-out catheterizations while the patients were in a supine position. There were a total of 116 paired measurements made. The BME-150A and the BVI 3000 demonstrated a correlation with the residual volume of 0.92 and 0.94, and a mean difference from the true residual volume of 7.8 and 3.6 ml, respectively. Intraclass correlation coefficients for the accuracy of the two bladder scans were 0.90 for BME-150A and 0.95 for BVI 3000. The difference of accuracy between the two models was not significant (p = 0.2421). There were six cases in which a follow-up evaluation of falsely elevated post-void residual urine volume measurements on the ultrasound studies resulted in comparatively low catheterized volumes, with a range of differences from 66 to 275.5 ml. These cases were diagnosed with an ovarian cyst, uterine myoma, or uterine adenomyosis on pelvic ultrasonography. The accuracy of the BME-150A is comparable to that of the BVI 3000 in estimating the true residual urine volumes and is sufficient enough for us to recommend its use as an alternative to catheterization.

Urodynamic distinctions between idiopathic detrusor overactivity and detrusor overactivity secondary to multiple sclerosis

Objectives To evaluate the urodynamic characteristics of neurogenic detrusor overactivity (NDO) secondary to multiple sclerosis (MS) compared with idiopathic DO (IDO) to determine whether urodynamic distinctions could differentiate the different etiologies of DO. Methods The urodynamic characteristics of DO in women with MS (n = 54) were compared with the overactive contractions found in women with lower urinary tract symptoms and IDO (n = 42). Among other parameters, the amplitude of the first overactive contraction, maximal detrusor contraction, and threshold volume for the first overactive contraction were evaluated to assess the DO severity. A sensitivity analysis using cutoff values determined from those urodynamic parameters that differed between the patient groups is presented. Results The amplitude of the first overactive contraction was statistically greater in the patients with MS and NDO compared with patients with IDO (28.3 cm H 2O versus 20.5 cm H 2O, P = 0.003), as was the maximal detrusor contraction (46.4 cm H 2O versus 30.8 cm H 2O, P = 0.002). The threshold volume for DO was greater among patients with NDO (186.8 mL versus 150.5 mL, P = 0.037), likely secondary to the elevated postvoid residual urine volume noted among patients with MS ( P = 0.049). Using a cutoff value of 30 cm H 2O for amplitude of the first overactive contraction achieved a positive predictive value of 88% for identifying MS in our data set. Conclusions The urodynamic characteristics of NDO differed significantly from those of IDO. Additional investigation is required to determine whether these differences are due to neurogenic influences directly on the detrusor muscle through aberrant innervation or by other mechanisms, such as enhanced outlet resistance during voiding.

Urge incontinence and impaired detrusor contractility in the elderly.

Among the elderly, both urge incontinence and elevated residual urine are common. When they occur together, they present a challenging clinical problem, called detrusor hyperactivity with impaired contractile function (DHIC). Impaired detrusor contractility has two aspects: elevated post-void residual urine volume and reduced detrusor contraction strength. Geriatric urge incontinence, especially in combination with reduced bladder sensation, is associated with specific cortical abnormalities: frontal and global cortical underperfusion and cognitive impairment. We have investigated, in 73 elderly incontinent patients, whether either aspect of impaired contractility is associated with urge incontinence, reduced sensation or these cortical abnormalities. For post-void residual urine, there are no significant associations. Detrusor contraction strength, however, is significantly increased (not impaired) if there is urge incontinence, reduced bladder sensation, or cortical underperfusion. Thus, DHIC appears to be a coincidental occurrence of two common conditions with different etiological factors.

Risk factors for an elevated postvoid residual urine volume in women with symptoms of urinary urgency, frequency and urge incontience.

The aim of this study was to identify factors in patients with symptoms of urgency/frequency or urge incontinence that predict that the postvoid residual urine volume (PVR) will be elevated. A restrospective chart review was carried out of all patients new to our urogynecology practice between June 1998 and May 1999, with symptoms of urgency, frequency and/or urge incontinence. Demographic variables, symptoms and physical findings were correlated with the presence of an elevated PVR (>100 ml) using logistic regression analysis. An elevated PVR was found in 10% (33/336) of patients with urge incontinence (UI). and in 5% (3/57) of patients with urgency/frequency without UI. In patients with UI the presence of pelvic organ prolapse (POP) > or = stage II, symptoms of voiding difficulty and the absence of the symptom of stress incontinence, predicted 82% of patients with an elevated PVR.

Factors predicting an elevated postvoid residual urine volume in ambulatory women

Objective: To identify factors present in patients with urinary urgency/frequency and/or urge incontinence which predict that the postvoid residual urine volume (PVR) will be elevated in order to simplify the screening process for ambulatory incontinent patients.Methods: A retrospective chart review of all new patients in our referral urogynecology practice between June 1998 and May 1999 was conducted. The study population was limited to patients with symptoms of urinary urgency/frequency and/or urge incontinence. Patient characteristics were evaluated as predictors of an elevated PVR (more than 100 mL within 10 minutes of voiding) using logistic regression analysis.Results: Three-hundred ninety-three charts satisfied criteria for review. We found an elevated PVR in 10% (33/336) of patients with the symptom of urge incontinence and in 5% (3/57) of patients with urgency/frequency without urge incontinence. In urge incontinent patients, we found that (1) the presence of pelvic organ prolapse stage II or greater, (2) the symptom of voiding difficulty, and (3) the lack of the symptom of stress incontinence predicted 80% of patients with an elevated PVR. In patients with urgency/frequency without urge incontinence, no reliable predictors of elevated PVR were found.Conclusions: In ambulatory women with urge incontinence, measurement of a PVR should precede consideration of anticholinergic therapy when there is pelvic organ prolapse to the hymen and/or the patient reports difficult voiding.

Myosin isoforms in female human detrusor.

The aim of this study was to document the relative proportions of two isoforms of myosin heavy chain in detrusor smooth muscle of women with detrusor overactivity and in asymptomatic controls. Women aged 35-65 with documented detrusor overactivity and without a history of neurologic disease, prior incontinence surgery, elevated post-void residual urine volume, or indwelling urinary catheter were eligible for the study. Full-thickness biopsies of extraperitoneal bladder dome were obtained at the time of laparotomy in six patients with documented detrusor overactivity and in a control group of eight continent patients. Biopsies were frozen in liquid nitrogen, crushed with a frozen mortar and pestle at -80 degrees C, and homogenized in buffer, and the extracts were electrophoresed on 6% polyacrylamide sodium dodecyl sulfate gels and stained with Coomassie blue. The gels were de-stained and then the protein bands were scanned with a densitometer. The mean patient age was 48 years (range, 36-59). Seven patients were Caucasian and seven patients were African American. Detrusor smooth muscle contains a mean of 34% (range, 27-43%) SM1 and 66% (range, 57-73%) SM2 isoforms. There was no difference in isoform composition when patients were compared according to urogynecologic diagnosis or according to race. In detrusor biopsies from women, approximately 34% of myosin is of the SM1 isoform and approximately 66% is of the SM2 isoform. This ratio is relatively constant in the two races studied and unchanged in women with detrusor overactivity. Animal models utilizing outlet obstruction of the bladder to provoke detrusor instability and detrusor hypertrophy are known to alter myosin isoform distribution and may not be appropriate models of detrusor instability in human females.