From the Guidelines
Elevated post-void residual (PVR) urine volume in female patients is most commonly caused by urinary retention due to bladder outlet obstruction or detrusor underactivity, as suggested by the most recent evidence 1. The causes of elevated PVR can be multifactorial, including:
- Pelvic organ prolapse (particularly cystocele or rectocele)
- Urethral stricture
- Neurological conditions affecting bladder function such as multiple sclerosis or diabetes mellitus
- Medications like anticholinergics, alpha-adrenergic agonists, and certain antidepressants that interfere with normal bladder contraction
- Recent pelvic surgery or childbirth causing temporary urinary retention due to inflammation or nerve damage
- Psychological factors like anxiety leading to dysfunctional voiding patterns
Evaluation of elevated PVR typically involves:
- A thorough history
- Physical examination including pelvic assessment
- Urinalysis to rule out infection
- Possibly urodynamic studies to assess bladder function, as recommended by the AUA/SUFU guideline 1
- Initial imaging, such as cystourethrography, may be requested to assess postvoid bladder volume or evaluate for associated abnormalities in atypical or complex cases 1
Treatment of elevated PVR depends on the underlying cause and may include pelvic floor physical therapy, medication adjustments, intermittent catheterization, or surgical intervention for anatomical issues 1. Addressing elevated PVR is crucial as it increases the risk of urinary tract infections and can lead to upper urinary tract damage if left untreated. The most recent evidence emphasizes the importance of a comprehensive evaluation and tailored treatment approach to manage elevated PVR and improve patient outcomes 1.
From the Research
Causes of Elevated Post-Void Residual (PVR) Urine Volume
- Older age is a significant factor associated with elevated PVR, as identified in studies 2, 3
- Prior incontinence surgery is also a predictor of elevated PVR, as found in research 2, 4
- History of multiple sclerosis is another independent predictor of elevated PVR, as noted in 2
- Vaginal prolapse stage 2 or greater is associated with elevated PVR, according to 2
- Genital organ prolapse is a common cause of bladder outlet obstruction, which can lead to elevated PVR, as discussed in 4
- Dysfunctional voiding is another cause of elevated PVR, as mentioned in 4, 5
- Detrusor underactivity (DU) may also contribute to elevated PVR, especially in older women, as suggested in 3
- Physical functioning, malnutrition, and risk of mortality are associated with elevated PVR in older female hip fracture patients, as found in 3
- Voiding dysfunction is common in women with stress incontinence, which can result in elevated PVR, as reported in 6
Associated Factors
- Urinary or fecal incontinence, difficulties in physical activities of daily living, and malnutrition are associated with elevated PVR, as identified in 3
- Nocturia, cognitive impairment, and depressive mood are not associated with elevated PVR, according to 3
- Low maximum flow rate and high detrusor contraction pressure during voiding are indicative of voiding dysfunction in women with stress incontinence, as found in 6