What is the normal post-void residual (PVR) bladder volume?

From the Guidelines

The normal post-void residual (PVR) bladder volume in adults is typically less than 50 mL, though values up to 100 mL are generally considered acceptable. After urination, the bladder should empty almost completely, with only a small amount of urine remaining. PVR volumes between 100-200 mL may indicate potential issues but aren't necessarily abnormal in all cases, especially in older adults. However, volumes consistently above 200 mL are generally considered abnormal and may suggest urinary retention requiring further evaluation.

Key Considerations

• PVR measurement is an important diagnostic tool in assessing bladder function and can be measured using either ultrasound (non-invasive) or catheterization (invasive) 1.
• The bladder's ability to empty properly depends on coordinated function between the detrusor muscle (which contracts during urination) and the urethral sphincter (which relaxes to allow urine flow) 1.
• Incomplete emptying can result from various conditions including obstruction, neurological disorders affecting bladder control, or detrusor muscle weakness, making PVR assessment valuable in diagnosing the underlying cause of urinary symptoms.

Recent Guidelines

• The 2023 European Association of Urology guidelines recommend against using antimuscarinic overactive bladder medications in men with a PVR volume of >150 ml, and also advise against prescribing combination treatment in men with a PVR volume of >150 ml 1.
• These guidelines suggest that PVR volumes above 150 mL may be associated with increased risk of adverse events or reduced efficacy of certain treatments.

Clinical Implications

• PVR volumes should be interpreted in the context of individual patient factors, including age, medical history, and symptoms.
• Clinicians should consider PVR assessment as part of the initial evaluation and ongoing follow-up for patients with relevant neurological conditions or other factors that may affect bladder function 1.
• The use of PVR measurements can inform treatment decisions and help identify patients who may require further evaluation or alternative therapies.

From the Research

Normal Post-Void Residual (PVR) Bladder Volume

The normal post-void residual (PVR) bladder volume can be determined by considering various studies.

• A study published in 2024 2 found that the 90th and 95th percentiles of PVR for men were 73.2 mL (25% of bladder volume) and 102.6 mL (30% of bladder volume), respectively, while for women they were 60.5 mL (21% of bladder volume) and 93.8 mL (27% of bladder volume), respectively.
• Another study from 2016 3 suggested that large PVR (>200-300 ml) may indicate marked bladder dysfunction, but there is no universally accepted definition of a significant residual urine volume.
• A pooled analysis of eleven controlled studies with alfuzosin published in 2001 4 found that a PVR volume of 100 mL or greater was observed in 60% of patients with a maximum flow rate (Qmax) less than 8 mL/s.

Factors Influencing PVR

Several factors can influence PVR, including:

• Bladder volume: A study published in 2024 2 found a significant nonlinear relationship between bladder volume and PVR.
• International Prostatic Symptom Score (IPSS): The same study found that PVR increased as IPSS increased.
• Gender: Women had lower PVR than men, according to the 2024 study 2.
• Maximum flow rate (Qmax): A pooled analysis published in 2001 4 found that PVR volume was related to Qmax.

Clinical Significance of PVR

PVR measurement is recommended in guidelines and recommendations on the management of lower urinary tract symptoms (LUTS) and urinary incontinence, as stated in a 2016 study 3. However, the level of evidence for this measurement is not high. A study published in 2001 4 found that acute urinary retention occurred mainly in patients with a PVR volume greater than 100 mL.