Abstract
Purpose of Review
Elevated post-void residual volume (ePVR) also known as chronic urinary retention (CUR) is a chronic condition of incomplete bladder emptying in the absence of pain or discomfort. ePVR may be secondary to several etiologies: obstructive, neurogenic, vascular, myogenic, or a combination of these. It can be further divided into symptomatic (e.g., accompanied with lower urinary tract symptoms), or asymptomatic. In this article, we sought to review the literature regarding definition of ePVR, etiology, clinical significance, initial assessment, treatment, and follow-up.
Recent Findings
We performed a systematic review of current literature and leading urology association guidelines regarding the management of CUR. We recommend using a cut off for of greater than 300mL, in two separate measurements at least 6 months apart for the definition of CUR. Patient with CUR should be divided to low- and high-risk patients, according to their risk of developing complication related to urinary stasis or high intravesical pressure. The management and follow-up recommendations are different in both group and should be aimed at reducing complications and improving quality of life. While low-risk asymptomatic patients may be followed conservatively, high-risk patients should be monitored closely for worsening renal function and interventions may be needed in the high-risk group.
Summary
CUR is a chronic condition whose pathogenesis and complications are not fully understood. Management and follow-up of patients with CUR should be tailored to patient risk. Further research is necessary to better understand the clinical course, pathophysiology, and optimal therapeutic and diagnostic approach.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol. 2008;180(1):47–54. This article is one of the pivotal studies reviewing the literature regarding CUR, it provides comprehensive review aiming to separate evidence-based, from expert-opinion-only arguments in the diagnosis and management of CUR patients.
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.
Professionals SO. EAU guidelines: management of non-neurogenic male LUTS [Internet]. Uroweb. [cited 2021 Oct 15]. Available from: https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/. The EAU guidelines summarize the evidence regarding numerous tests and treatments in the management of male LUTS, which helps assessing their role in CUR patients.
Asimakopoulos AD, De Nunzio C, Kocjancic E, Tubaro A, Rosier PF, Finazzi-Agrò E. Measurement of post-void residual urine. Neurourol Urodyn. 2016;35(1):55–7.
Kim TH, Kim HS, Park JW, Lim OK, Park KD, Lee JK. Falsely elevated postvoid residual urine volume in uterine myoma. Ann Rehabil Med. 2017 Apr;41(2):332–6.
Ballstaedt L, Woodbury B. Bladder post void residual volume. In: StatPearls [Internet]. Treasure Island. (FL): StatPearls Publishing; 2021. [cited 2021 Dec 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539839/.
Negro CLA, Muir GH. Chronic urinary retention in men: how we define it, and how does it affect treatment outcome. BJU Int. 2012;110(11):1590–4. This study reviews the impact of chronic urinary retention on patients outcome. Negro et al, provide a high-quality review on the evidence supporting various definitions of CUR, as well as the role of CUR in the diagnosis and management of CUR patients.
Non-neurogenic chronic urinary retention: consensus definition, management strategies, and future opportunities-American Urological Association [Internet]. [cited 2021 Dec 19]. Available from: https://www.auanet.org/guidelines/guidelines/chronic-urinary-retention. This is one of the key resources in the management of PVR and provides evidence-based, risk-stratified approach of the management of chronic urinary retention. The AUA guidelines build a consensus definition of CUR, which allows standartization and future research.
Decalf V, Monaghan TF, Denys MA, Petrovic M, Pieters R, Weiss JP, et al. Circadian patterns in postvoid residual and voided percentage among older women with urinary incontinence. J Clin Med. 2020;9(4):922.
Abrams PH, Dunn M, George N. Urodynamic findings in chronic retention of urine and their relevance to results of surgery. BMJ. 1978;2(6147):1258–60.
Osman NI, Chapple CR. Contemporary concepts in the aetiopathogenesis of detrusor underactivity. Nat Rev Urol. 2014;11:639–48.
Does defective volume sensation contribute to detrusor underactivity? - Smith - 2015 - Neurourology and Urodynamics - Wiley Online Library [Internet]. [cited 2022 Jan 11]. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.22653.
Wein AJ. Re: does defective volume sensation contribute to detrusor underactivity? J Urol. 2017;197(1):218–8.
Stoffel JT. Non-neurogenic chronic urinary retention: what are we treating? Curr Urol Rep. 2017;18(9):74.
Aldamanhori R, Chapple CR. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol. 2017 May;27(3):293–9.
Truzzi JCI, Almeida FMR, Nunes EC, Sadi MV. Residual urinary volume and urinary tract infection—when are they linked? J Urol. 2008;180(1):182–5.
Breyer BN, Shinohara K. Re: residual urinary volume and urinary tract infection—when are they linked? J Urol. 2009;181(2):919–20.
Töz E, Kurt S, Sahin Ç, Canda MT. Frequency of recurrent urinary tract infection in patients with pelvic organ prolapse. Res Rep Urol. 2015 Jan;28(7):9–12.
May M, Brookman -Amissah Sabine, Hoschke B, Gilfrich C, Braun KP, Kendel F. Post-void residual urine as a predictor of urinary tract infection—is there a cutoff value in asymptomatic men? J Urol. 2009;181(6):2540–4.
Omli R, Skotnes LH, Mykletun A, Bakke AM, Kuhry E. Residual urine as a risk factor for lower urinary tract infection: a 1-year follow-up study in nursing homes. J Am Geriatr Soc. 2008;56(5):871–4.
Hampson SJ, Noble JG, Rickards D, Milroy EJG. Does residual urine predispose to urinary tract infection? Br J Urol. 1992;70(5):506–8.
Barabas G, Mölstad S. No association between elevated post-void residual volume and bacteriuria in residents of nursing homes. Scand J Prim Health Care. 2005;23(1):52–6.
Kolman C, Girman CJ, Jacobsen SJ, Lieber MM. Distribution of post-void residual urine volume in randomly selected men. J Urol. 1999;161(1):122–7.
Scofield S, Kaplan SA. Voiding dysfunction in men: pathophysiology and risk factors. Int J Impot Res. 2008;20(S3):S2–10.
Roehrborn CG, Kaplan SA, Lee MW, Slawin KM, McVary KT, Kusek JW, et al. 1638: baseline post void residual urine volume as a predictor of urinary outcomes in men with BPH in the MTOPS study. J Urol. 2005;173(4S):443–4.
Rule AD, Jacobson DJ, McGREE ME, Girman CJ, Lieber MM, Jacobsen SJ. Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol. 2005;174(4 Part 1):1317–22.
Mochtar CA, Kiemeney LALM, Van Riemsdijk MM, Laguna MP, Debruyne FMJ, De La Rosette JJMCH. Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J Urol. 2006;175(1):213–6.
The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction - Thomas - 2005 - BJU International - Wiley Online Library [Internet]. [cited 2022 Jan 11]. Available from: https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2005.05815.x.
Styles RA, Neal DE, Griffiths CJ, Ramsden PD. Long-term monitoring of bladder pressure in chronic retention of urine: the relationship between detrusor activity and upper tract dilatation. J Urol. 1988;140(2):330–4.
Rule AD, Lieber MM, Jacobsen SJ. Is benign prostatic hyperplasia a risk factor for chronic renal failure? J Urol. 2005;173(3):691–6.
Yamasaki T, Naganuma T, Iguchi T, Kuroki Y, Kuwabara N, Takemoto Y, et al. Association between chronic kidney disease and small residual urine volumes in patients with benign prostatic hyperplasia. Nephrology. 2011;16(3):335–9.
Hong SK, Lee ST, Jeong SJ, Byun SS, Hong YK, Park DS, et al. Chronic kidney disease among men with lower urinary tract symptoms due to benign prostatic hyperplasia. BJU Int. 2010;105(10):1424–8.
Childs MA, Mynderse LA, Rangel LJ, Wilson TM, Lingeman JE, Krambeck AE. Pathogenesis of bladder calculi in the presence of urinary stasis. J Urol. 2013;189(4):1347–51. Childs et al studied prospectively the impact of urinary stasis secondary to bladder outlet obstruction on stone development in male patients.
Philippou P, Volanis D, Kariotis I, Serafetinidis E, Delakas D. Prospective comparative study of endoscopic management of bladder lithiasis: is prostate surgery a necessary adjunct? Urology. 2011;78(1):43–7.
Huang W, Cao JJ, Cao M, Wu HS, Yang YY, Xu ZM, et al. Risk factors for bladder calculi in patients with benign prostatic hyperplasia. Medicine (Baltimore). 2017;96(32):e7728.
Verhamme KMC, Sturkenboom MCJM, Stricker BHC, Bosch R. Drug-induced urinary retention. Drug Saf. 2008;31(5):373–88.
Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary retention in adults: evaluation and initial management. Am Fam Physician. 2018;98(8):496–503.
Bright E, Cotterill N, Drake M, Abrams P. Developing and validating the International Consultation on Incontinence Questionnaire bladder diary. Eur Urol. 2014;66(2):294–300.
Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I—initial work-up and medical management. J Urol. 2021;206(4):806–17.
Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014;10(6):CD006744.
Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol. 2017;58(Suppl 2):S90–8.
Martín-Merino E, García-Rodríguez LA, Massó-González EL, Roehrborn CG. Do oral antimuscarinic drugs carry an increased risk of acute urinary retention? J Urol. 2009;182(4):1442–8.
Sacco E, Bientinesi R. Mirabegron: a review of recent data and its prospects in the management of overactive bladder. Ther Adv Urol. 2012;4(6):315–24.
Lerner LB, McVary KT, Barry MJ, Bixler BR, Dahm P, Das AK, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part II—surgical evaluation and treatment. J Urol. 2021;206(4):818–26.
Campeau L, Al-Afraa T, Corcos J. Evaluation and management of urinary retention after a suburethral sling procedure in women. Curr Urol Rep. 2008;9(5):412–8.
Jonas U, Fowler CJ, Chancellor MB, Elhilali MM, Fall M, Gajewski JB, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2001;165(1):15–9.
Gross C, Habli M, Lindsell C, South M. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16(4):249–53.
White WM, Dobmeyer-Dittrich C, Klein FA, Wallace LS. Sacral nerve stimulation for treatment of refractory urinary retention: long-term efficacy and durability. Urology. 2008;71(1):71–4.
Szymański JK, Słabuszewska-Jóźwiak A, Jakiel G. Fowler’s syndrome—the cause of urinary retention in young women, often forgotten, but significant and challenging to treat. Int J Environ Res Public Health. 2021;18(6):3310.
Coolen RL, Groen J, Scheepe JR, Blok BFM. Transcutaneous electrical nerve stimulation and percutaneous tibial nerve stimulation to treat idiopathic nonobstructive urinary retention: a systematic review. Eur Urol Focus. 2021 Sep;7(5):1184–94.
Kavanagh A, Stewart J, Boone T. Reduction Cystoplasty. In: Chapple CR, Wein AJ, Osman NI, editors. Underactive bladder [Internet]. Cham: Springer International Publishing; 2017 [cited 2022 Jan 18]. p. 63–67. Available from: https://doi.org/10.1007/978-3-319-43087-4_9.
Ninkovic M, Stenzl A, Schwabegger A, Bartsch G, Prosser R. Free neurovascular transfer of latissimus dorsi muscle for the treatment of bladder acontractility: II Clinical results. J Urol. 2003;169(4):1379–83.
Expectant long-term follow-up of patients with chronic urinary retention - Abello - 2019 - Neurourology and Urodynamics - Wiley Online Library [Internet]. [cited 2022 Jan 18]. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.23853.
Bates TS, Sugiono M, James ED, Stott MA, Pocock RD. Is the conservative management of chronic retention in men ever justified? BJU Int. 2003;92(6):581–3.
Al-Hayek S, Thomas A, Abrams P. Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor. Scand J Urol Nephrol Suppl. 2004;215:101–8.
Funding
This study supported by Grant P30 CA008748 from the National Cancer Institute, National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Mekayten, M., Sandhu, J.S. Management of Elevated Post-Void Residual Volume. Curr Bladder Dysfunct Rep 18, 201–209 (2023). https://doi.org/10.1007/s11884-023-00706-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-023-00706-6