From the Guidelines
Treatment for a female patient with elevated post void residual (PVR) volume should prioritize identifying and addressing the underlying cause, with initial management focusing on behavioral modifications and potentially progressing to pharmacological or surgical interventions as necessary. When managing elevated PVR, it's crucial to consider the potential benefits and harms of interventions, as outlined in urodynamic studies 1. The goal is to decrease potential morbidity by identifying patients with significant urinary retention and facilitating appropriate treatment selection and monitoring.
Key considerations in the management of elevated PVR include:
- Behavioral modifications: timed voiding, double voiding, and pelvic floor muscle exercises to improve bladder emptying.
- Pharmacological treatment: alpha-adrenergic blockers like tamsulosin or alfuzosin to relax the bladder neck, or bethanechol to increase bladder contractility in patients with detrusor underactivity.
- Clean intermittent catheterization (CIC) for patients with significant urinary retention, performed 3-4 times daily using sterile technique.
- Investigation into the underlying cause, which may include neurological conditions, pelvic organ prolapse, medication side effects, or bladder outlet obstruction.
- Urodynamic testing to evaluate bladder function if conservative measures fail.
- Surgical interventions such as sling revision or sacral neuromodulation may be considered in refractory cases.
Monitoring treatment success is typically achieved by measuring PVR volumes, with values below 100 mL generally considered acceptable. It's essential to weigh the benefits of measuring PVR, including identifying significant urinary retention and guiding treatment, against the low risks of assessment, such as urinary tract infection and urethral trauma, which can be mitigated with ultrasound determination of PVR 1.
From the FDA Drug Label
Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria). The treatment options for a female patient with elevated post void residual (PVR) volume may include oxybutynin as it is used to relieve symptoms of bladder instability. However, elevated PVR volume is not directly addressed in the label, and the use of oxybutynin for this specific condition is not explicitly stated.
- The label mentions urinary leakage and urge incontinence which might be related to elevated PVR, but it does not provide a direct answer to the question. 2
From the Research
Treatment Options for Elevated Post Void Residual (PVR) Volume in Females
- The treatment options for a female patient with elevated post void residual (PVR) volume include intermittent self-catheterization 3, anticholinergic medication if PVR is low 4, and botulinum toxin injections 5, 6.
- Intermittent self-catheterization is a safe and simple technique that can help patients gain control over their bladders and prevent urinary tract infections 3.
- Botulinum toxin injections can be effective in treating overactive bladder symptoms, but may require repeated injections and can have tolerability issues 5, 6.
- Surgical repair of pelvic organ prolapse (POP) can also improve bladder emptying and resolve elevated PVR in women with nonneurogenic-elevated PVR 7.
Identifying Risk Factors for Elevated PVR
- Risk factors for elevated PVR include older age, prior incontinence surgery, history of multiple sclerosis, greater American Urological Association Symptom Score, vaginal parity greater than 2, greater pad use, and stage 2 or greater vaginal prolapse 4.
- Patients with elevated PVR are more likely to have anterior prolapse stage 2 or 3, but complaints of incontinence, incomplete bladder emptying, and overactive bladder do not differ between groups 7.
Predicting Resolution of Elevated PVR
- Most patients with elevated PVR can be reassured that bladder emptying will improve after surgical repair of POP 7.
- The resolution rate of elevated PVR urine volume in patients undergoing reconstructive surgery for pelvic organ prolapse is high, with all women in one study having postoperative resolution of elevated PVR 7.