What are the diagnostic tests for urinary frequency (pollakiuria)?

From the Guidelines

Testing for urinary frequency should start with a thorough medical history and physical examination, followed by laboratory tests such as urinalysis, and a voiding diary to record fluid intake, urination frequency, and voided volumes for 2-3 days, as recommended by the AUA/SUFU guideline amendment 2019 1. When evaluating urinary frequency, it is essential to consider various factors, including fluid intake patterns, medication use, and associated symptoms like pain or urgency.

• A physical examination should include abdominal and pelvic exams to check for any abnormalities.
• Laboratory tests are crucial, starting with urinalysis to check for infection, glucose (indicating possible diabetes), or blood.
• A urine culture may be ordered if infection is suspected, and additional tests like post-void residual measurement using ultrasound or catheterization can help check for incomplete bladder emptying.
• Uroflowmetry can measure urine flow rate, and cystoscopy can visualize the bladder lining, while urodynamic studies may be necessary to evaluate bladder function during filling and emptying.
• Blood tests for kidney function, glucose levels, and calcium may also be ordered to rule out underlying conditions like diabetes or kidney disease. According to the AUA guideline on management of benign prostatic hyperplasia (2003) 1, patient voiding diaries can be helpful in selected patients, especially those with nocturia as the predominant symptom. The Infectious Diseases Society of America's clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities (2008 update) 1 recommends that urinalysis and urine cultures should not be performed for asymptomatic residents, and diagnostic laboratory evaluation of suspected UTI should be reserved for those with acute onset of UTI-associated symptoms and signs. However, the most recent and highest quality study, the AUA/SUFU guideline amendment 2019 1, prioritizes the use of a voiding diary to measure treatment response and reliably measure urinary frequency. Therefore, a voiding diary is the most recommended initial test for evaluating urinary frequency, as it provides valuable information on fluid intake, urination frequency, and voided volumes.

From the Research

Testing for Urinary Frequency

• Urinary frequency is a symptom of overactive bladder (OAB), which is a highly prevalent condition affecting up to 12% of the adult population 2.
• The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies 2.
• Simple office testing, such as urinalysis and culture, and assessment of post-void residual urine, should be part of the work-up of all patients with symptoms of OAB 3.
• Supplemental testing, including comprehensive urodynamic testing, endoscopic evaluation of the lower urinary tract, imaging of the upper urinary tract, neurologic evaluation, or spine imaging, may be considered in certain situations, such as:
  • Cases where routine evaluation raises the suspicion of a problem or condition that either needs further evaluation or may predispose the patient to failure of therapy 3.
  • Patients who are refractory to treatment and those with significant neurological disease 3.
• A urinalysis (UA) should be performed to evaluate for microhematuria to rule out the possibility of malignancy, especially in patients with lower urinary tract symptoms 4.
• The timing of symptom onset can help distinguish between OAB and urinary tract infection (UTI), with UTI symptoms being generally acute and OAB symptoms being generally chronic 4.
• Measurement of postvoid residual (PVR) volume of urine can help evaluate urinary retention, which can be a cause of urinary frequency 5.