Bladder Post-void Residual Volume Research Articles

Agreement and Reliability of Patient-measured Postvoid Residual Bladder Volumes

BackgroundPost-void residual bladder volume (PVR) measurement in the non-healthcare setting is a valuable opportunity for remote monitoring of voiding dysfunction patients. We hypothesized that PVR self-measurement using a smart-device portable ultrasound system with artificial intelligence would demonstrate high reliability, strong agreement with provider measurement, and be preferred over provider measurements. MethodsPatients were enrolled during outpatient Urology visits. PVRs were measured in triplicate by providers using each of the following: an FDA-cleared (standard) bladder scanner, the portable ultrasound probe using ultrasound images (ButterflyTM US image mode), and the portable ultrasound probe using abstract images (ButterflyTM abstract mode). Subjects self-measured PVRs in triplicate using both imaging modes and reported their experiences via questionnaire. Reliability was assessed via intraclass correlation (ICC). Agreement between methods was assessed via Bland-Altman analyses using a clinically acceptable difference threshold of 50 mL. Results50 patients were enrolled. ICCs ranged from 0.95-0.98 for each method. 95% limits of agreement between standard bladder scanner and patient self-measurement were -71.73 mL and 86.73 mL using ButterflyTM US image mode and -93.84 mL and 112.52 mL using ButterflyTM abstract mode, respectively. Most patients preferred self-measurement over provider measurement (74% vs 26%, respectively). ConclusionsPatient self-measurement of PVR using smart-device integrated portable ultrasound probes is feasible, reliable, and preferred by patients. Limits of agreement between patient self-measurement and standard bladder scanner measurements exceeded our clinically acceptable difference threshold, though the inherent error of ultrasound-based bladder volume measurements should be considered. Longitudinal PVR assessments in non-healthcare settings may facilitate remote monitoring of voiding dysfunction patients.

Transperitoneal Transvesical Robotic Simple Prostatectomy for a Greater Than 400G Enlarged Prostate Using the Multiport Robot

Introduction: In this video we demonstrate our surgical technique for approaching a massively enlarged prostate through a transabdominal transvesical approach using the multiport robotic platform. Materials and Methods: Here we present a case involving a 76-year-old man with history of enlarged prostate causing urinary retention with several episodes of gross hematuria, and clot retention. His prostate specific antigen was 18 ng/mL, and a prior transperineal prostate biopsy was negative for malignancy. The patient had a medical history of hypertension. Results: Operative time was 4 hours 48 minutes. Blood loss was 300 mL. Patient length of stay was 2 days. On follow-up 3 months postoperatively, the patient's postvoid residual bladder volume was 68 cc, International Prostate Symptom Score was 3, and quality of life score was 0. Conclusions: Transabdominal transvesical approach using the multiport robotic platform to perform simple robot-assisted prostatectomy is a feasible and safe option for treatment of a massively enlarged prostate. No competing financial interests exist. Patient consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music source: https://www.youtube.com/watch?v=R0j2o9DyI04 Runtime of video: 6 mins 22 secs

Management of postpartum urinary retention: a multi-center randomized controlled trial

To assess the most effective catheterization strategy to resolve overt postpartum urinary retention (PUR). A prospective randomized controlled trial was conducted at 4 university-affiliated medical centers. Women with PUR (bladder volume >150 mL) up to 6 hours following vaginal or cesarean delivery were randomly allocated to one of two protocols: intermittent catheterization every 6 hours (up to 4 times) or an indwelling urinary catheter for 24 hours (continuous catheterization), until full resolution (defined as post-void residual volume < 150 mL, estimated by either catheter or transabdominal ultrasound). If PUR was not resolved after 24 hours an indwelling catheter was inserted for additional 24 hours in both groups. The primary outcome was mean time to PUR resolution. Secondary outcomes included post-catheter urinary tract infection (UTI) rate and the length of hospital stay. We estimated that 73 women/group would have to be included to have 90% power to detect a 13 hours difference in the primary outcome (from 3024 to 1724 hours). From 1/2020 to 6/2022, 182 women were eligible for enrollment, while 147 women were eventually randomized: 73 in the intermittent group and 74 women in the continuous catheterization group. As shown in table 1, baseline and delivery characteristics were not different between the groups, including mode of delivery. Mean post-void residual bladder volume preceding catheterization was similar between the groups (813410 mL vs. 924448 mL, p=0.12) (Table 2(. Mean time to PUR resolution was significantly shorter in the intermittent catheterization group (10.211.8 vs. 26.59.0 hours, p< 0.001), with 75% and 93% resolution rates after one and two catheterizations, respectively. Satisfaction rate was higher in all categories among intermittent catheterization group. No difference was found in UTI rate or hospital stay. An intermittent catheterization for PUR following delivery, compared to an indwelling catheter for 24-hours, is associated with a quicker PUR resolution, and a higher satisfaction rate, without increasing complications rate.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

8772 The Impact of Acute Urinary Retention Volume on Postoperative Urinary Dysfunction Following Robotic Sacrocolpopexy

<h3>Study Objective</h3> Sacrocolpopexy (SCP) for pelvic organ prolapse is typically performed with a midurethral sling (MUS) to treat or prevent postoperative stress urinary incontinence (SUI). A known complication is the development of postoperative urinary dysfunction, namely obstructed voiding, chronic urinary retention (CUR) and eventual sling release. This study aims to investigate whether the degree of acute urinary retention (AUR) is predictive of longer-term sequelae. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Academic-affiliated community hospital. <h3>Patients or Participants</h3> All patients (n=708) undergoing a robotic SCP with transobturator MUS placement by a single urogynecologist between January 2012 and March 2022 stratified by their post-void residual bladder volumes (PVRBV) were included in this study. <h3>Interventions</h3> Patients were grouped by their degree of PVRBV: ≤150mL (n=397), >150 and ≤300mL (n=111), >300 and ≤450mL (n=84), and >450mL (n=116). <h3>Measurements and Main Results</h3> Higher volumes of AUR had a statistically significant increase in the percentage chance risk of CUR. (6.3%, 16.2%, 10.7%, 14.7%, p<0.05). A non-statistically significant distribution was observed between PVRBV and requirement for eventual sling release (3%, 1.8%, 0%, 6%, p=0.08). There were no differences in other long term postoperative sequelae amongst variable degrees of acute PVRBV including urinary symptoms, need for postoperative medications or return to the emergency department or hospital readmissions. Patients with greater PVR volumes had lower body mass index (28.7, 27.7, 27.2, 26.8 kg/m², p<0.05). Other demographic variables were similar amongst groups. <h3>Conclusion</h3> Increasing BMI has a protective effect from developing CUR. Higher PVRBV in excess of 150mL were associated with a greater propensity for CUR. This had a trend toward requiring sling release and/or revision. Future studies are necessary to determine whether the degree of AUR is related to the procedure or pre-existing bladder dysfunction.

The voiding pattern of aterm neonates

Introduction: The concept of voiding patterns in neonates had not been completely understood. The voiding pattern in neonates was physiologically different from that in older children. The brain's development affects voiding patterns in frequency, bladder volume, and post-void residual bladder volume, as the child keeps growing. This study aims to understand the physiological neonates' voiding system in Indonesian newborns.Materials and methods: We evaluate ten normal-born and 12 perinatology-hospitalized aterm neonates without anatomical or physiological urologic abnormalities at RSUP Haji Adam Malik from October to November 2019. We used an observational study, assessing the voiding physiology in newborns, including voiding frequency and urine volume. Infants with a history of urinary tract infection or present bacteriuria confirmed by urine culture were excluded. Voiding volume, frequency, bladder capacity, and residual volume were measured. Results: We collected a total of 22 patients, with 12 patients were perinatology-hospitalized and ten patients were healthy neonates with ten subjects were male, and 12 subjects were female. There was no correlation between voiding frequency and total voiding volume with perinatology-hospitalized, healthy neonates, and sex. (p&gt;0.05). Independent T-test was performed with a p-value for volume, frequency, bladder capacity, and residual volume of 0.225, 0.112, 0.031, and 0.663. We got a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized. No significant differences were noted in other variables. Pearson correlation analysis was performed to determine the correlation between total voiding volume and age of gestation, body weight, length, head circumference, abdominal circumference, and chest circumference. The correlation coefficients were 0.772, 0.869, 0.623, 0.698, 0.079, 0.523 in order, with significant p-value in the age of gestation, body weight, length, head circumference, and chest circumference. There were correlations between total voiding volume and age of gestation, body weight, length, head circumference, and chest circumference. Conclusion: In conclusion, we found there was a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized.

Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria.

To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501minutes; P=0.001), and second stage (50 versus 32minute; P<0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P<0.01), catheterization during labor (P<0.01), perineal injury (P<0.01), and episiotomy (P<0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24hours. This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.

Postpartum urinary retention and its associated obstetric risk factors among women undergoing vaginal delivery in tertiary care hospital

IntroductionPostpartum urinary retention (PUR) is not an uncommon consequence of bladder dysfunction after vaginal delivery. Despite its ubiquity, morbidity and discomfort brought to the postpartum women, it’s a poorly discussed condition. Patients with Overt PUR are unable to void spontaneously within 6h of vaginal delivery and those with Covert PUR are able to void spontaneously but have a post void residual bladder volume (PVRV) of >150mL. Reported incidences of PUR vary widely ranging from 1.7 %–17.9 %. Aim and ObjectivesTo identify the prevalence and obstetric risk factors for PUR after vaginal delivery in order to identify women with increased risk of PUR. Materials and methodsThe PVRV of women who delivered vaginally was measured after the first spontaneous micturition by ultrasonography. PVRV of more than 150mL was considered as covert PUR. Patient data including age, obstetric history, mode of delivery, duration of labor, PVRV were compared between women with and those without PUR. ResultsOf 878 included women, the overall prevalence of PUR after vaginal delivery was 12.9 %, the prevalence of overt and covert PUR were 1.8 % and 11.04 % respectively. Parturient who were primigravidae, had perineal injury, instrumental delivery, birth weight >3.5kg and a longer duration of second stage of labor were risk factors for developing PUR. ConclusionAny misdiagnosis or delay in diagnosis of PUR can cause bladder over distension leading to irreversible detrusor damage. Hence vigilant monitoring and early detection of PUR helps in facilitating timely interventions and prevention of immediate and long term sequelae.

Bladder dysfunction in women with diabetes mellitus

Introduction: Lower urinary tract dysfunctions secondary to type 2 DM are common, chronic and costly disorders. The incidence of diabetic bladder dysfunction was estimated range between 43% and 87% for type 1 and 25% for type 2 diabetes. Ultrasonography is an easy-to-use, fast, safe, non-invasive, painless, pleasant and valuable method of assessing Bladder Post-Void Residual Volume (PVR). Aim: To investigate prevalence of bladder dysfunction and its relation with risk factors, clinical features of diabetic cystopathy in women with diabetes, to identify the values predicting to have postvoid residual volume of the risk factors. Methods: A cross sectional descriptive study, a cohort of 84 female inpatients and outpatients with diabetes mellitus who were treated at Hue University of Medicine and Pharmacy Hospital from 08/2017 to 08/2019 and 84 healthy control subjects were enrolled, the patients were carried out clinical finding, taken blood tests, and estimated postvoid residual volume using 2D ultrasound. Results: the postvoid residual volume was presented in 67 cases (79.80%), the clinical symptoms of diabetic cystopathy were reported in 75% of women with diabetes. Blood glucose, HbA1c, clinical symptoms of diabetic cystopathy, postural hypotension and diabetic peripheral neuropathy were associated with postvoid residual volume. The HbA1c level had a great capability to predict who had postvoid residual volume, at HbA1c cutoff value of 9.1%, Se 65.67%, Sp 94.12%, AUC 0.811, p &lt; 0.001. Conclusion: Bladder dysfunction made up a highly prevalent in women with poor glycemic control. Key words: bladder dysfunction, diabetic cystopathy, bladder postvoid residual volume (PVR)

Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease.

PurposeTo assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms.MethodsWe performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms.ResultsWe included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009).ConclusionsDO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.

Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound.

The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). Twenty women participated, with an average age of 27.95 ± 3.15years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.

Wireless ambulatory urodynamic study: A 6‐year retrospective review in a tertiary paediatric urological referral centre

AimUrodynamic study is a functional assessment of the lower urinary tract. It has an essential role in the evaluation of paediatric patients with lower urinary tract symptoms, be it due to neurogenic or nonneurogenic causes. Since 2013, we have introduced wireless ambulatory form of the study. In the present study, we performed a baseline review of our paediatric urodynamic service within a 6‐year period to determine its indications, outcomes and complications.Patients and MethodsA retrospective review of all urodynamic studies performed between August 2011 and April 2017 in patients &lt;18 years of age was performed. Demographics, including age and sex, and indications were collected. Urodynamic parameters, including type of catheter used, presence of detrusor overactivity, bladder compliance, end‐fill detrusor pressure, maximum voiding detrusor pressure, postvoid residual bladder volume and bladder emptying efficiency, were collected. Complications from either catheter insertion or the urodynamic study itself were documented.ResultsSixty‐seven studies were done between the study period in 55 patients (16 females and 39 males). Fifty‐eight ambulatory studies with natural and conventional fill were performed since 2013. The median age at study was 2.1 years (range 0.1–17 years). Indications included myelodysplasia (61 per cent, n = 41 studies), bilateral high‐grade vesicoureteric reflux (18 per cent, n = 12), dysfunctional voiding (15 per cent, n = 10) and patient with posterior urethral valve (6 per cent, n = 4). Suprapubic catheters were used in 62 studies in patients with urethral sensation, and transurethral catheters were used in five studies. Overall, 53 studies were considered abnormal (79.1 per cent). No complications resulted from suprapubic catheter insertion or urodynamic studies.ConclusionAmbulatory urodynamic studies using our unit’s protocol remain safe and child friendly, with minimal complications and high patient and parent satisfaction.

Acupuncture for the treatment of post-partum urinary retention

Study objectivesThe aims of the present study were to evaluate acupuncture as an alternative treatment to an indwelling catheter for women with postpartum urinary retention, and to evaluate the accuracy of sonographic estimation of bladder volume by portable bedside equipment in women postpartum. Study backgroundPost-partum urinary retention is a common obstetric complication. The accepted method for diagnosing post void residual bladder volume is by ultrasound or catheterization. However, the accuracy of bedside sonographic evaluation of bladder volume in women postpartum is controversial due to anatomical and technical issues. The traditional treatment of urinary retention is catheterization for variable lengths of time. Acupuncture, while an accepted treatment method for urinary retention in traditional societies in the Far East, has not been proven scientifically to resolve the problem. Therefore, the aims of our study were to evaluate acupuncture as an alternative treatment to catheterization for urinary retention, and to evaluate the accuracy of sonographic estimation of bladder volume by portable bedside ultrasound in women postpartum. Materials and methodsThe study was a prospective randomized case-controlled trial conducted in 55 women post-partum with urinary retention. All patients underwent a pre and post treatment sonographic evaluation of bladder volume. Women with urinary retention were given the choice of treatment by acupuncture or catheterization. Acupuncture was performed by an experienced acupuncturist licensed in Traditional Chinese Medicine and point selection was based on Meridian theory and clinical experience. ResultsIn the acupuncture group, 23 women (92%) achieved spontaneous micturition within one hour following treatment. Bedside sonographic evaluation of bladder volume showed excellent correlation to actual volume as measured by catheterization (r2 = 0.988). ConclusionAcupuncture proved to be an excellent alternative to catheterization in treatment of women with postpartum urinary retention.

Impact of systematic urinary catheterization protocol in delivery room on covert postpartum urinary retention: a before-after study

We investigated whether implementation of a routine catheterization procedure in labor improves covert postpartum urinary retention (cPUR) rates. We conducted a prospective before-after study. 121 women admitted to delivery room in the observational group, and 82 in the intervention group, in a tertiary university hospital in Southern France were included. All patients in the intervention group were systematically catheterized 2 hours after delivery. cPUR was screened for in both groups. The primary end-point was cPUR (post-void residual bladder volume >150 ml when voided volume is >150 mL). The rate of cPUR decreased from 50% (60 out of 121 patients) in the observational group to 17% (14/82) in the intervention group (OR = 0.21; 95% Confidence Interval [0.13;0.58]; p < 0.001). Similarly, in the subgroup of patients who underwent instrumental delivery, the rate of cPUR was lower in the intervention group (18%, 2/11) than in the observational group (65%, 15/23) (p = 0.02). Systematic intermittent bladder catheterization immediately postpartum could decrease cPUR. Further studies are necessary to assess the long-term outcomes and improve understanding of postpartum voiding dysfunction.

Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery.

Introduction and hypothesisPostpartum urinary retention (PUR) is a common consequence of bladder dysfunction after vaginal delivery. Patients with covert PUR are able to void spontaneously but have a postvoid residual bladder volume (PVRV) of ≥150 mL. Incomplete bladder emptying may predispose to bladder dysfunction at a later stage of life. The aim of this cross-sectional study was to identify independent delivery-related risk factors for covert PUR after vaginal delivery in order to identify women with an increased risk of covert PUR.MethodsThe PVRV of women who delivered vaginally was measured after the first spontaneous micturition with a portable bladder-scanning device. A PVRV of 150 mL or more was defined as covert PUR. Independent risk factors for covert PUR were identified in multivariate regression analysis.ResultsOf 745 included women, 347 (47 %) were diagnosed with covert PUR (PVRV ≥150 mL), of whom 197 (26 %) had a PVRV ≥250 mL (75th percentile) and 50 (7 %) a PVRV ≥500 mL (95th percentile). In multivariate regression analysis, episiotomy (OR 1.7, 95 % CI 1.02 – 2.71), epidural analgesia (OR 2.08, 95 % CI 1.36 – 3.19) and birth weight (OR 1.03, 95 % CI 1.01 – 1.06) were independent risk factors for covert PUR. Opioid analgesia during labour (OR 3.19, 95 % CI 1.46 – 6.98), epidural analgesia (OR 3.54, 95 % CI 1.64 – 7.64) and episiotomy (OR 3.72, 95 % CI 1.71 – 8.08) were risk factors for PVRV ≥500 mL.ConclusionsEpisiotomy, epidural analgesia and birth weight are risk factors for covert PUR. We suggest that the current cut-off values for covert PUR should be reevaluated when data on the clinical consequences of abnormal PVRV become available.

English

This study aims to determine if systematic use of bladder scan accurately identifies more women with postpartum urinary retention compared with diagnosis using clinical signs and symptoms, alone. A prospective, quasi experimental study was performed at the Department of Obstetrics and Gynecology, County Hospital Ryhov, Jonkoping, Sweden. A total of 252 women participated in this study; they were women who gave birth between the period of March and April, 2011. One hundred and twenty-six women were included in an experimental group, they received ultrasound scanning of post-void residual bladder volume for identification of urinary retention; patients were catheterized if post-void residual bladder volume was ≥400 ml. A control group of 126 women, matched by parity and age, were also included. The latter group were catheterized on clinical signs or symptoms of urinary retention. Twenty-one women in the experimental group were identified as having post-void residual bladder volume ≥400 ml compared to 9 in the control group, verified by catheterization (p 120 min, active pushing >30 min and perineal tear. Oxytocin infusion and perineal tear were independent risk indicators in a multivariable regression analysis. Systematic bladder scanning identifies more women with postpartum urinary retention in women with vaginal delivery than diagnosis by clinical signs and symptoms, alone. Oxytocin infusion and perineal tear are independent risk indicators for urinary retention in new delivered women. Key words: Postpartum urinary retention, postpartum voiding dysfunction, bladder scanning, catheterization, birth.

Measurement of Post-void Residual Bladder Volumes in Hospitalized Older Adults

BackgroundIt is commonly recommended to catheterize or closely follow up patients with post-void residual volumes of 150 mL or more, but the frequency of such findings in geriatric hospitalized patients and the need for intervention are unclear. MethodsPost-void residual volumes were measured by ultrasound examination within 14 hours of admission in 464 patients aged 70 years or more who were hospitalized in a regional hospital general internal medicine department. Outcome variables included the need for an indwelling catheter and complications of urinary retention during the hospitalization. ResultsPost-void residual volumes of ≥150 mL were common (23.9%; 111/464) and had the following distribution: 150 to 299 mL, 13.1% (61/464); 300 to 499 mL, 6.4% (30/464); and 500 mL or more, 6% (28/464). The rate of indwelling catheters was 3.2% (15/464). Results of post-void residual volumes did not predict the need for indwelling catheters in those without other criteria, although those with indications for indwelling catheters had a significantly higher frequency of post-void residual volumes ≥500 mL (P < .001) compared with those without such indications. ConclusionsWe conclude that urinary retention in hospitalized geriatric patients is common, but measurements of post-void residual volumes did not have definite clinical utility. However, the study had limited power to determine the benefits or potential harms of urinary catheterization for elevated post-void residual volumes.

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

To assess the obstetrics risk factors for postpartum urinary retention after vaginal delivery. Of 234 women with a vaginal delivery, 19 (8.1%) women who had postpartum urinary retention were cases, and 215 (91.9%) women who did not were controls. Postpartum urinary retention was defined as the presence of postvoid residual bladder volume ≥150 mL or the inability to void within 6 hours after vaginal delivery. Logistic regression analysis identified risk factors for urinary retention. Prolonged duration of the second stage of labor (OR=0.46, 95% CI for OR=0.06-3.67, p<0.001), presence of episiotomy (OR=0.07, 95% CI for OR=0.01-0.68, p=0.022) and perineal laceration (OR=97.09, 95% CI for OR=7.93-1188.93, p<0.001), and birth weight of >4000 g for the newborn (OR=0.04, 95% CI for OR=0.01-0.20, p<0.001) were found as independent risk factors for postpartum urinary retention after vaginal delivery. Postpartum urinary retention after vaginal delivery is a relatively common condition. Awareness of risk factors, including prolonged second stage of labor, episiotomy, perineal lacerations, and macrosomic birth, may allow us to take the necessary precautions against this complication.

Postpartum voiding dysfunction: Identifying the risk factors

Postpartum urinary retention (PPUR) (also known as voiding dysfunction) is a common problem, defined as the inability to completely void after giving birth. If voiding dysfunction is not recognised, bladder overdistension can lead to denervation, detrusor atony and prolonged voiding dysfunction. To describe the incidence of PPUR amongst postpartum women undergoing routine bladder scanning and to identify the factors that lead to postpartum voiding dysfunction. A retrospective analysis of all postpartum women at Mater Health Services, Brisbane between February and December 2012 was undertaken. Routinely collected postvoid residual bladder volumes (PVRBV) were reported using a bladder scanner at four and six hours and two to three days postbirth or following removal of an indwelling catheter (IDC). The characteristics of women with or without increased PVRBV were analysed. Postvoid residual bladder volumes at four-hours postbirth/removal of IDC were available for 5558 women of whom 281 (5.1%) had a residual volume measured >150 mL. Obstetric factors explored included mode of birth, method of analgesia or anaesthesia, duration of labour, degree of perineal trauma, birth weight, gestation, parity, maternal age and body mass index. After controlling for confounders, nulliparity (aOR 1.53; 95% CI 1.05-2.26), birth by caesarean section (aOR 2.21; 95% CI 1.10-4.41) and 3rd/4th degree perineal trauma (aOR 2.01; 95% CI 1.09-3.72) were significant independent predictors of PPUR. Following the introduction of a protocol of timed voiding and routine measurement of PVRBV after birth/removal of IDC, PPUR is uncommon. Adopting a risk-factor-based approach to PVRBV screening is not supported by these data.

A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate

Introduction: Monopolar transurethral resection of the prostate(TURP) is the gold standard surgical therapy for men with lower urinarytract symptoms due to benign prostatic hyperplasia. Althoughgenerally considered safer, TURP experience is limited in Canada.Methods: Forty-three patients from 5 Canadian centres were randomizedto TURP with either bipolar or monopolar platforms.Patients underwent baseline determinations of American UrologicalAssociation (AUA) symptom score, peak urinary flow rate, postvoidresidual bladder volume and transrectal ultrasound prostatevolume. Primary outcome measures were improvement in AUAsymptom score, quality of life assessment and bother assessment.Secondary outcomes included procedural times, duration of catheterization,length of hospitalization, complications and the degreeof thermal artifact in tissue specimens. Patients were followed for6 months.Results: Twenty-two patients were treated with bipolar and 21 withmonopolar TURP. Preoperative demographics were not statisticallydifferent between groups. Postoperative data collection times wereequivalent in AUA symptom, quality of life, bother and sexualfunction assessments. No differences were observed in the proceduretime (60.7 min, bipolar vs. 47.4, monopolar) or the durationof urethral catheterization (1.5 days, bipolar vs. 1.1, monopolar).More patients in the bipolar group were discharged on the sameday of surgery. There were no differences in the degree of tissuethermal artifact or complication rate.Conclusion: This trial suggests equivalent short-term outcomes formen undergoing monopolar or bipolar TURP.

Phenotypic characteristics of early Wolfram syndrome

BackgroundWolfram Syndrome (WFS:OMIM 222300) is an autosomal recessive, progressive, neurologic and endocrinologic degenerative disorder caused by mutations in the WFS1 gene, encoding the endoplasmic reticulum (ER) protein wolframin, thought to be involved in the regulation of ER stress. This paper reports a cross section of data from the Washington University WFS Research Clinic, a longitudinal study to collect detailed phenotypic data on a group of young subjects in preparation for studies of therapeutic interventions.MethodsEighteen subjects (ages 5.9–25.8, mean 14.2 years) with genetically confirmed WFS were identified through the Washington University International Wolfram Registry. Examinations included: general medical, neurologic, ophthalmologic, audiologic, vestibular, and urologic exams, cognitive testing and neuroimaging.ResultsSeventeen (94%) had diabetes mellitus with the average age of diabetes onset of 6.3 ± 3.5 years. Diabetes insipidus was diagnosed in 13 (72%) at an average age of 10.6 ± 3.3 years. Seventeen (94%) had optic disc pallor and defects in color vision, 14 (78%) had hearing loss and 13 (72%) had olfactory defects, eight (44%) had impaired vibration sensation. Enuresis was reported by four (22%) and nocturia by three (17%). Of the 11 tested for bladder emptying, five (45%) had elevated post-void residual bladder volume.ConclusionsWFS causes multiple endocrine and neurologic deficits detectable on exam, even early in the course of the disease. Defects in olfaction have been underappreciated. The proposed mechanism of these deficits in WFS is ER stress-induced damage to neuronal and hormone-producing cells. This group of subjects with detailed clinical phenotyping provides a pool for testing proposed treatments for ER stress. Longitudinal follow-up is necessary for establishing the natural history and identifying potential biomarkers of progression.