Accuracy of total bladder volume and residual urine measurements: comparison between real-time ultrasonography and catheterization

The practical value of ultrasonography as a rapid means to accurately determine total bladder volumes and residual urine volume was assessed. Transverse and sagittal bladder diameters were measured with real-time ultrasonography in 50 women: (1) before uroflowmetry, (2) before supine-postvoiding catheterization, (3) before standing catheterization, and (4) after standing catheterization. Calculated bladder volumes, by use of the measured diameters, for each of eight formulas from the literature were compared with their corresponding measured total urine volume, total residual volume, and standing residual volume. The lower limit of ultrasonographic visualization of urine in the bladder was approximately 42 ml. No correlation existed between calculated ultrasound bladder volumes and measured urine volumes for any of the eight formulas. Standing residual volumes were measured in 96% of cases. Ultrasonography cannot as yet rapidly measure bladder volumes accurately. Catheterization remains the best method of assessing postvoid residuals: supine measurements, the gold standard, should be augmented by standing measurements when more accurate volumes are required.     

Accuracy of Bladder Scanning in the Assessment of Postvoid Residual Volume

ObjectiveTo compare the accuracy of the 3D portable ultrasound with catheterization in the assessment of postvoid residual (PVR) urine volume among women in the urogynaecology clinic.MethodsA prospective study was performed, assessing 101 women. After the patient voided four ultrasound (US) assessments were carried out using the BladderScan BVI 3000; the patient was then catheterized. The reproducibility of the US measurements and the difference between the two methods were assessed using Bland and Altman plots. The strength of the relationship was measured by a simple Pearson correlation coefficient.ResultsThe results showed that 3D scanner measurements were highly reproducible and were also found to correlate significantly with catheterized volume (r = 0.79, 95% CI 0.70–0.85, P < 0.001). The mean difference between the two methods was 12.9 mL (95% CI 5.5–20.2 mL, P < 0.001).ConclusionIn determining PVR volumes, the portable ultrasound BladderScan BVI 3000 is an accurate alternative to bladder catheterization.     

间歇性导尿在宫颈癌根治术后患者膀胱功能恢复及预防泌尿系统感染的应用研究

目的:分析间歇性导尿在宫颈癌根治术后患者膀胱功能恢复及预防泌尿系统感染的临床意义。方法:选取中国人民解放军总医院妇产科2014年1月—2016年12月收治的早期宫颈癌(FIGOⅠA期、ⅠB期、ⅡA期)手术后残余尿量不合格患者182例,于手术后第10天拔除尿管,测残余尿量≥100 mL者为不合格。随机分为观察组(89例)和对照组(93例),观察组采用间歇性导尿及个体化精准护理,对照组采用留置尿管及常规护理。记录2组患者一般情况,比较2组患者残余尿量合格需要的时间和泌尿系统感染情况。结果:2组患者年龄、手术方式、FIGO分期、残余尿量分级比较差异无统计学意义(均P>0.05)。残余尿量100~200 mL、201~350 mL者中,观察组残余尿量合格需要的时间少于对照组,差异有统计学意义(均P<0.001),观察组泌尿系统感染发生率低于对照组,差异有统计学意义(均P<0.05)。结论:间歇性导尿能够促进宫颈癌根治术后患者膀胱功能恢复、降低泌尿系统感染发生率,该方法操作简便、患者易接受、临床效果满意,适合推广应用。     

Ultrasonic validation of residual bladder volume in postvaginal hysterectomy patients

Transverse and sagittal bladder diameters were measured with real-time ultrasound in 80 patients (100 measurements) during the first 2 days of postvaginal hysterectomy to assess the residual bladder volume and compared with the catheterization volume for the same patients. The sonographic method, with a 97.7% specificity and a negative predictive value of 89.5%, proved to be specific enough to eliminate the necessity of routine catheterization for measuring residual bladder volumes of greater than or equal to 150 cm3, thus decreasing the incidence of some major postoperative complications that can occur due to unnecessary catheterization.     

Is portable three-dimensional ultrasound a valid technique for measurement of postpartum urinary bladder volume?

ObjectiveTo determine the accuracy of bladder volume (BV) measurement and to identify factors that influenced the ultrasound bladder scanner (UBS) measurement of BV in postpartum women compared with transurethral catheterization.Materials, methods and results: A total of 190 paired measurements were performed on 190 women aged between 16 and 47 years. Majority of the women (36.9%) were in their first parity (range: 1-9). The mean BV was 159.46 mL [standard deviation (SD) = 99.78; range: 17–593 mL] on three-dimensional (3D) UBS and 143.76 mL (SD = 104.89; range: 2-588 mL) on catheterization. The mean difference between the two values was 15.70 mL (SD = 69.31, p < 0.001). The Foley’s catheter was clamped for a minimum of 30 minutes and a maximum of 260 minutes. The UBS measurements were highly correlated with the BV obtained by catheterization (r = 0.819; p < 0.001). There was no significant difference between UBS and catheterized volume in a different volume subgroup. There were 35 cases (18.2%) with the difference in measurement of more than 25%. Twenty-five cases were associated with a catheterized volume less than 50 mL. There were a total of 33 cases with true BV of less than 50 mL, and only eight cases (24.24%) had an accurate measurement. The UBS tends to overestimate BV between 2 and 270 mL in this group. There was a significant linear relationship between the difference in measurement and body weight and duration of clamping.ConclusionMeasurement of BV in immediate postpartum period using UBS is comparable with urethral catheterization. The accuracy of measurement is affected by body weight and increasing amount of BV.     

Ultrasound assessment of bladder volume: is it valid after delivery?

AIM: To assess the validity of a commercially available bladder volume scanner in the puerperium. METHODS: A prospective blinded comparison of bladder volume measurement after vaginal delivery using the BladderScan bladder volume instrument (BVI) 3000 and Foley catheter; comparison using the intraclass correlation coefficient. RESULTS: The mean difference between the two measurements was a 130-mL over-measurement by the bladder scanner (range: -156 mL to +422 mL). The intraclass correlation coefficient was 0.23 (95% confidence interval 0.00, 0.59). CONCLUSIONS: The BladderScan BVI 3000 is not an accurate instrument to assess bladder volume the day after vaginal delivery. Some of the discrepancy might relate to use of the Foley catheter as the reference standard. Further comparison between the BladderScan and a short female catheter or real time ultrasound is indicated.     

Bladder training after surgery for stress urinary incontinence: is it necessary?

Eighty-nine consecutive patients with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence entered this study. Forty women had a revised Pereyra procedure and 49 had a Burch retropubic urethropexy. All had a suprapubic Bonnano catheter for postoperative bladder drainage. Postoperatively, patients were randomly allocated to "bladder training" (N = 44) or "nonbladder training" (N = 45) protocols. "Bladder training" consisted of scheduled clamping and unclamping of the catheter, whereas the "nonbladder training" patients had continuous bladder drainage throughout their postoperative period. Postvoiding residual urine volume was measured twice daily after the patient had voided with a symptomatically full bladder. The catheter was removed once residual volume was 50 mL or less. The bladder training protocol had no effect on resumption of spontaneous voiding after surgery. There was no significant change in length of postoperative bladder catheterization or in urinary tract infection rate among women with or without bladder training.     

Reliability of an automatic ultrasound system in the post partum period in measuring urinary retention

BACKGROUND: Urinary retention in the post partum period may lead to short- and long-term complications. OBJECTIVE: To investigate the reliability of an automatic ultrasound system to measure the volume of the bladder post partum. METHODS: About 85 women, who delivered vaginally were observed 6 hr post partum. When the bladder volume measured by BladderScan BVI 3000 was more than 300 ml, it was compared with the bladder volume measured by catheterization. RESULTS: Ten additional catheterizations were performed by using BladderScan BVI 3000, when compared with the number of estimated cathetharizations based on clinical indications. Eight women had a residual volume of more than 300 ml, of whom two got an indwelling catheter. Using Bland-Altman methods, there was no significant difference in volumes measured by BladderScan BVI 3000 or by catheterization. Also, there was no significant difference between two observers. CONCLUSION: The BladderScan BVI 3000 is a reliable and non-invasive method to recognize urinary retention in the post partum period.     

Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse

OBJECTIVE: This study was undertaken to determine whether surgery for advanced pelvic organ prolapse corrects the voiding dysfunction commonly associated with this condition and if so to evaluate the ability of preoperative voiding studies to predict such correction. STUDY DESIGN: We reviewed the records of all women who underwent surgery at our center between January 1996 and June 1999 for stage 3 or 4 pelvic organ prolapse. Patients were included in this review if they had a postvoid residual volume of >100 mL documented by catheterization on at least 2 occasions, had no normal postvoid residual volumes documented, and had undergone preoperative multichannel urodynamic testing that included an instrumented voiding study. Demographic and urodynamic data were analyzed for the ability to predict whether the elevated postvoid residual volume would be resolved after surgery. RESULTS: Thirty-five patients satisfied the criteria for inclusion in the review. Twenty-six had stage 3 pelvic organ prolapse and 9 had stage 4 pelvic organ prolapse. The mean preoperative postvoid residual volume was 226 mL (range, 105-600 mL). Thirty-one patients (89%) had normal postvoid residual volumes after surgery. As a predictor of elevated postoperative postvoid residual volumes, the preoperative voiding study (performed with the prolapse reduced) had a sensitivity of 66%, a specificity of 46%, a positive predictive value of 12%, and a negative predictive value of 93%. CONCLUSION: In our center a preoperative voiding study performed with the pelvic organ prolapse reduced most accurately predicted postoperative voiding function when results of the voiding study were normal. Most patients with advanced pelvic organ prolapse and elevated postvoid residual volume had normalization of the postvoid residual volume after surgical correction of the pelvic organ prolapse.     

Are portable bladder scanning and real-time ultrasound accurate measures of bladder volume in postnatal women?

Real-time ultrasound and portable bladder scanners are commonly used instead of catheterisation to determine bladder volumes in postnatal women but it is not known whether these are accurate. Change in bladder volumes measured by ultrasound and portable scanners were compared with actual voided volume (VV) in 100 postnatal women. The VV was on average 41 ml (CI 29 - 54 ml) higher than that measured by ultrasound, and 33 ml (CI 17 - 48 ml) higher than that measured by portable scanners. Portable scanner volumes were 9 ml (CI -8 - 26 ml) higher than those measured by ultrasound. Neither method is an accurate tool for detecting bladder volume in postnatal women.     

Predictive Factors for Voiding Dysfunction after Surgery for Deep Infiltrating Endometriosis

Study ObjectiveTo evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE).DesignSingle-center retrospective cohort study.SettingUniversity hospital.PatientsA total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan.InterventionsSurgical resection of the DIE nodule from the dorsal compartment.Measurements and Main ResultsAfter surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3–18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001).ConclusionPostoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.     

Uroflowmetry for predicting postoperative voiding difficulties in women with stress urinary incontinence

Pre-operative knowledge of uroflowmetry and postvoiding residual urine volumes in a group of 45 women undergoing urinary incontinence surgery failed to predict risks of postoperative voiding difficulties. Only one out of nine patients needing prolonged post-operative bladder drainage (greater than or equal to 7 days) gave a pre-operative history of voiding difficulties. More than half the patients (5/9) who needed prolonged catheterization had normal flow rates were able to resume spontaneous voiding within 7 days following incontinence surgery.     

Post-voiding residual volume in 154 primiparae 3 days after vaginal delivery under epidural anesthesia

OBJECTIVES: To use 3-dimensional ultrasonography (3D-US) to determine the frequency of post-voiding residual volume (PVRV) > or =100 mL in primiparae 3 days after receiving epidural anesthesia for vaginal delivery. Potential relationships between day-3 PVRV > or =100 mL and obstetrical-pediatric parameters, especially those possibly implicated in post-obstetrical bladder dysfunction, were examined. STUDY DESIGN: We recruited 154 primiparae who vaginally delivered term singletons following uncomplicated pregnancies in the maternity unit of a French teaching hospital. All women had been systematically catheterized 2-h postpartum to measure precisely the volume of urine retained. On the morning of discharge (day 3), when the patient felt the urge to urinate, her 3D-US pre-voiding bladder volume was determined with BladderScan (BVI-3000), then her spontaneously voided urine was collected to accurately quantify its volume and 3D-US was repeated immediately to evaluate the PVRV. PVRV > or =100 mL on day 3 was considered pathological. RESULT: Among these 154 women, 88 (57%) felt the need to urinate and 97 (63%) had a retained volume > or =500 mL at 2-h postpartum. On day-3 postpartum, the median [range] volumes for the entire cohort were: 426.7 [158-999.7] mL 3D-US-measured pre-voiding, 350 [15-1000] mL collected by spontaneous urination, 82.2 [5.3-433.3] mL 3D-US-determined post-voiding; PVRV exceeded 100 mL for 55 (36%). According to our univariate analysis, no factor considered was able to predict PVRV > or =100 mL on day 3. CONCLUSION: Our observations confirmed the existence of PVRV > or =100 mL on day 3 in more than one-third of these primiparae who delivered vaginally under epidural anesthesia. No obstetrical-pediatric factor could be implicated in this bladder dysfunction. Therefore, we recommend frequent and systematic non-invasive 3D-US monitoring of all postpartum patients at least until day 3 to avoid excessive urine retention.     

减少宫颈癌根治术后尿潴留发生方法分析

目的 探讨降低宫颈癌根治术后尿潴留发生率的有效方法。方法 回顾性分析中国医科大学附属第一医院2001年1月至2008年12月行宫颈癌根治术治疗的ⅠA2~ⅡA期宫颈癌患者188例,术后应用药物提高膀胱顺应性、锻炼膀胱功能,观察术后膀胱恢复情况及对术后患者进行长期随访。结果 188例患者中发生尿潴留28例,发生率为14.89%(28/188),其中残余尿量100~200 mL者 14例,＞200~300 mL者7例,＞300~400 mL 者6例,＞800 mL 者1例（808 mL）。结论 宫颈癌根治术后做好相关预防尿潴留的措施,如锻炼膀胱功能、尽早应用提高膀胱顺应性的药物,可有效降低尿潴留的发生率。     

Prospective comparison of indwelling bladder catheter drainage versus no catheter after vaginal hysterectomy

OBJECTIVE: This study compares the postoperative outcomes of patients in whom indwelling bladder catheterization or no catheter was used after vaginal hysterectomy. STUDY DESIGN: One hundred women undergoing inpatient vaginal hysterectomy were randomly assigned to have an indwelling Foley catheter for 24 hours or no catheter after the procedure. Data regarding postoperative morbidity were recorded, and a clean voided urine specimen for urinalysis and culture was obtained 48 hours and 2 weeks after surgery. RESULTS: The study groups were similar with respect to demographics and surgical indications. Two patients in the catheterized group required recatheterization after the catheters were removed. None of the subjects in the no-catheter group required a catheter. There was a significantly higher incidence of fever in the catheter group. No differences were found in the incidence of positive urine cultures between the study groups at 48 hours (8 vs 14, p = 0.227) and 2 weeks (6 vs 1, p = 0.111), respectively. CONCLUSION: Indwelling catheterization appears unnecessary after routine vaginal hysterectomy. However, catheter placement for 24 hours does not contribute significantly to postoperative morbidity. (AM J Obstet Gynecol 1994;170:1815-21.)     

Uroflowmetry for predicting postoperative voiding difficulties in women with stress urinary incontinence

Summary. Pre-operative knowledge of uroflowmetry and postvoiding residual urine volumes in a group of 45 women undergoing urinary incontinence surgery failed to predict risks of postoperative voiding difficulties. Only one out of nine patients needing prolonged post-operative bladder drainage (7 days) gave a pre-operative history of voiding difficulties. More than half the patients (5/9) who needed prolonged catheterization had normal flow rates pre-operatively and five of the nine patients with reduced flow rates were able to resume spontaneous voiding within 7 days following incontinence surgery.     

Basic understanding of urodynamics

Urodynamic investigations are an important tool aiding the clinical management of patients with lower urinary tract symptoms, such as overactive bladder, urinary incontinence, and voiding dysfunction. Urodynamic investigations can be non-invasive or invasive. Non-invasive tests include uroflowmetry and ultrasound measurement of post-void residual urine volumes. Invasive tests involve urethral catheterization to measure bladder pressure, and placement of a catheter either in the vagina or the rectum to measure abdominal pressure. The detrusor pressure is obtained by subtracting abdominal pressure from bladder pressure. Invasive urodynamics carry a low risk of urinary tract infection. The International Continence Society has published standards on good urodynamic practice and the terminology of lower urinary tract function. Urodynamic investigations should be performed by a trained clinician who can understand urodynamics on a physical and technical level, as well as the physiology and pathophysiology of the lower urinary tract.     

Erroneous statement regarding 2D ultrasound fetal urinary bladder volume measurement

The aim of the current paper is to inform the readers of an erroneous statement on the standard deviation (SD) when estimating the volume of fetal urinary bladder by 2D ultrasound. In the Archives of Gynecology and Obstetrics 2007; 276 (4), page 345-349, the authors Peixoto-Filho F.M. et al. refer to some studies presented by our group versus other studies regarding volume estimation of the fetal urinary bladder, in particular the ellipsoid method pioneered by Stuart Campbell in 1973 and the sum-of-cylinders method from our group. In our studies the volume estimation method was improved in three steps using methodological modifications. The SD was reduced from 17.3-10.9% to 12.9-5.5%, and 8.8-3.5% (bladder volumes 5-40 mL) The reductions were accompanied by P-values of 0.0270 (1 vs. 2) and 0.0543 (2 vs. 3), respectively. When comparing method 3 vs. 1 the P value was 0.0032. The SD reduction using method 3 vs. 2 did not reach statistical significance, however. Using this lack of significance on the 5% significance level, to prove that there were no improvements at all with our methodological modifications of the 2D ultrasound, as done by the authors, is misleading.     

Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women

OBJECTIVE: To estimate mean postvoid residual (PVR) volumes among perimenopausal and postmenopausal women without significant lower urinary tract or pelvic organ prolapse symptoms. METHODS: Patients presenting for well-women encounters were offered study participation. Women with a history of urinary incontinence greater than twice per week, urinary retention, symptomatic pelvic organ prolapse, or neurologic disorders were excluded. Pelvic relaxation, if present, was characterized according to the pelvic organ prolapse quantification system. Within 10 minutes of spontaneously voiding, PVR volume was assessed with bladder ultrasonography. RESULTS: A total of 96 patients were enrolled; mean age was 60+/-11 years. The majority (80%) were postmenopausal; 30% had a previous hysterectomy. Most women (92%) had some degree of prolapse; the median stage was one, most commonly involving the anterior compartment (70%). The median PVR volume was 19 mL (range 0-145 mL); the mean PVR volume was 24+/-29 mL. Only 15% of patients had a PVR volume greater than 50 mL, and 95% had a PVR volume 100 mL or less. Only age 65 years or older was associated with a higher mean PVR volume; hormone therapy, vaginal atrophy, parity, and stage of asymptomatic prolapse did not affect PVR volumes. CONCLUSION: Most asymptomatic perimenopausal and postmenopausal women had a PVR volume less than 50 mL, which was unaffected by multiple factors that were thought to potentially affect bladder function. Establishing "normal" volumes in this population may aid in developing recommendations regarding appropriate bladder function and retention criteria for women who are symptomatic or those who have had pelvic floor surgery.     

Ultrasonographic evaluation of bladder volume]

Twelve women of gynecologic dispensary of Hospital del Salvador are studied, making measurements of several ultrasound parameters of urinary bladder (diameters and perimeters), with known volumes instilled through catheterization. The results are mathematically and statistically studied with computer getting a formula of easy management to obtain the vesical volume. This formula is advantageously compared with others of literature. Advantages of ultrasound measurement of vesical volume are stressed in patients with uro-gynecologic pathology.