What are the treatment options for a patient with elevated post void residual (PVR) volume?

From the Guidelines

Treatment for elevated post void residual (PVR) volume should prioritize addressing the underlying cause and severity of the condition, with a focus on minimizing morbidity, mortality, and improving quality of life. The approach to managing elevated PVR involves a combination of behavioral modifications, pharmacological interventions, and, in some cases, surgical interventions. Behavioral modifications include timed voiding, double voiding, and reducing fluid intake before bedtime 1. Pharmacological treatment may involve alpha-blockers such as tamsulosin, alfuzosin, or silodosin to relax the bladder neck and prostate, improving outflow 1. For patients with benign prostatic hyperplasia (BPH), 5-alpha reductase inhibitors like finasteride or dutasteride may be added to reduce prostate size over 3-6 months 1. Some key points to consider in the management of elevated PVR include:

• The potential benefits of measuring PVR, including identifying patients with significant urinary retention and facilitating selection and implementation of treatment 1.
• The risks associated with assessing PVR, such as urinary tract infection and urethral trauma, which can be minimized with ultrasound determination of PVR 1.
• The importance of addressing the underlying cause of elevated PVR, whether it be prostatic enlargement, bladder outlet obstruction, or neurogenic bladder dysfunction 1.
• The need for a comprehensive approach to management, incorporating behavioral modifications, pharmacological interventions, and surgical interventions as necessary 1. In patients with significant retention (typically PVR >300 mL) or those who fail medical therapy, intermittent self-catheterization or indwelling catheterization may be necessary, with surgical interventions like transurethral resection of the prostate (TURP), laser prostatectomy, or urethral stents considered for persistent cases.

From the Research

Treatment Options for Elevated Post Void Residual (PVR) Volume

Elevated post void residual (PVR) volume is a condition where the bladder does not empty completely after urination, leading to a range of complications. The treatment options for this condition depend on the underlying cause and severity of the condition.

• Assessment and Measurement: The first step in treating elevated PVR is to assess and measure the PVR volume. This can be done using ultrasound bladder scanners 2 or urethral catheterization 3.
• Identifying Risk Factors: Certain factors such as older age, prior incontinence surgery, history of multiple sclerosis, and vaginal prolapse can increase the risk of elevated PVR 4.
• Anticholinergic Medication: Anticholinergic medication can be used to treat overactive bladder symptoms, but it is recommended to measure PVR before initiating treatment 4.
• Catheterization: Catheterization may be necessary for patients with high PVR volumes, especially if they are at risk of urinary tract infections 5.
• Surgical Intervention: In some cases, surgical intervention may be necessary to improve bladder emptying, especially if the patient has a high PVR volume and is at risk of urinary tract infections 5.

Management of Elevated PVR

The management of elevated PVR involves a range of strategies, including:

• Monitoring: Regular monitoring of PVR volumes to assess the effectiveness of treatment and prevent complications 6.
• Lifestyle Modifications: Lifestyle modifications such as increasing fluid intake, avoiding caffeine and alcohol, and practicing pelvic floor exercises can help improve bladder emptying 2.
• Medical Treatment: Medical treatment such as anticholinergic medication and alpha-blockers can help improve bladder emptying and reduce symptoms 4.
• Catheterization: Catheterization may be necessary for patients with high PVR volumes, especially if they are at risk of urinary tract infections 5.

Complications of Elevated PVR

Elevated PVR can lead to a range of complications, including:

• Urinary Tract Infections: Elevated PVR can increase the risk of urinary tract infections, especially if the patient has a high PVR volume 5.
• Urinary Retention: Elevated PVR can lead to urinary retention, which can cause discomfort, pain, and other complications 6.
• Bladder Damage: Elevated PVR can cause bladder damage over time, leading to chronic complications such as bladder dysfunction and incontinence 2.

It is essential to note that the treatment options and management strategies for elevated PVR may vary depending on the individual patient's needs and circumstances, and should be guided by a healthcare professional 4, 6, 2, 5, 3.