From the Guidelines
Elevated post-void residual (PVR) urine volume in females is most commonly caused by detrusor underactivity or bladder outlet obstruction, or a combination of both, as suggested by the most recent guideline 1.
Causes of Elevated PVR
The causes of elevated PVR in females can be multifactorial, including:
- Detrusor underactivity, where the bladder muscles cannot contract effectively to empty the bladder
- Bladder outlet obstruction, which can be due to various factors such as urethral strictures, tumors, or pelvic organ prolapse
- Neurological conditions like multiple sclerosis or diabetes that affect nerve signals to the bladder
- Medications such as anticholinergics, antidepressants, and opioids that interfere with bladder contraction
- Functional issues like habitual incomplete emptying or psychological factors
- Age-related changes in bladder function and pregnancy or postpartum complications
Diagnosis and Evaluation
Proper diagnosis of elevated PVR requires a thorough medical history, physical examination, and sometimes urodynamic testing to determine the specific cause and guide appropriate treatment 1. The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) recommend assessing PVR urine volume in patients with stress urinary incontinence (SUI) who are considering invasive therapy 1. Additionally, the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder suggests performing PVR to exclude urinary retention in patients with concomitant emptying symptoms 1.
Treatment Implications
Elevated PVR can have significant implications for treatment outcomes, particularly in patients undergoing surgical therapy for SUI. Patients with an elevated preoperative PVR may be at increased risk for transient or permanent postoperative voiding difficulties following urethral bulking injection therapy or SUI surgery 1. Therefore, it is essential to assess PVR urine volume and perform further evaluation with non-invasive uroflow, urodynamics (UDS), and/or cystoscopy if PVR is elevated 1.
From the Research
Causes of Elevated Post-Void Residual (PVR) Urine Volume in Females
The causes of elevated post-void residual (PVR) urine volume in females can be attributed to various factors, including:
- Older age, with studies suggesting that women over 55 years are at a higher risk of elevated PVR 2
- Prior incontinence surgery, which can lead to increased PVR due to potential bladder outlet obstruction 2, 3
- History of multiple sclerosis, a neurological condition that can affect bladder function 2
- Vaginal parity greater than 2, which may contribute to pelvic floor weakness and increased PVR 2
- Stage 2 or greater vaginal prolapse, which can cause bladder outlet obstruction and elevated PVR 2, 3
- Detrusor overactivity, which can lead to impaired bladder emptying and increased PVR 4, 5
- Bladder outlet obstruction, which can be caused by various factors, including genital organ prolapse, previous incontinence surgery, or dysfunctional voiding 3, 4
- Neurological factors, such as cerebrovascular accident and Parkinsonian disease, which can affect bladder function and lead to elevated PVR 5
Clinical Factors Associated with Elevated PVR
Clinical factors associated with elevated PVR in females include:
- Greater American Urological Association Symptom Score 2
- Greater pad use 2
- Low maximum flow rate and high detrusor contraction pressure during voiding, indicating voiding dysfunction 6
- Post-void residue (PVR) ≥200 mL, which is a significant predictor of detrusor overactivity following extensive vaginal pelvic reconstructive surgery 5