Abstract
Introduction and hypothesis
It has been claimed that post-void residual urine (PVR) below 150 ml rules out voiding dysfunction in women with stress urinary incontinence (SUI) and provides license to perform sling surgery. The cut-off of 150 ml seems arbitrary, not evidence-based, and so we sought to investigate the ability of PVR < 150 ml to exclude voiding dysfunction.
Methods
We retrospectively reviewed the charts of all patients who underwent invasive urodynamics from 1 January 2013 to 31 December 2013. Voiding dysfunction was diagnosed if both the invasive urodynamic and the free flow showed abnormal results. We registered the PVR in patients with voiding dysfunction and divided them into groups with PVR < 150 ml and PVR ≥ 150 ml. Patients were then analyzed for bladder outlet obstruction and detrusor underactivity.
Results
Of the 205 patients undergoing invasive urodynamics in 2013, a total of 20 had voiding dysfunction, 2 with PVR ≥ 150 ml. Eighteen patients had PVR < 150 ml (range 0–50 ml); 9 had bladder outlet obstruction while 7 had detrusor underactivity. Two patients were uncategorized. Out of the 20 patients, 7 had no symptoms or complaints indicating voiding dysfunction.
Conclusions
Patients with voiding dysfunction often have normal PVR and so PVR < 150 ml cannot exclude voiding dysfunction. All patients should be evaluated using free flow measurements along with PVR to obtain a reliable, objective measurement of their voiding pattern, before anti-incontinence surgery.
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Conflicts of interest
Niels Klarskov and Gunnar Lose have been cooperating with Laborie in the development and supply of catheters for the use of urethral pressure reflectometry, a urodynamic investigation. Laborie has not given any financial support. Niels Klarskov has received honoraria as a speaker/investigator and travel grants from Astellas. Gunnar Lose has received honoraria as an investigator from Astellas. Yasmine Khayyami has no conflicts of interest.
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Khayyami, Y., Klarskov, N. & Lose, G. Post-void residual urine under 150 ml does not exclude voiding dysfunction in women. Int Urogynecol J 27, 467–473 (2016). https://doi.org/10.1007/s00192-015-2854-y
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DOI: https://doi.org/10.1007/s00192-015-2854-y