From the Guidelines
The next best step for a patient with benign prostatic hyperplasia (BPH), impaired renal function (Creatinine 1.6), and hyperglycemia (Glucose 212), regarding Neurogenic Bladder (NBS) assessment is a post-void residual volume check. This approach is supported by the most recent guideline amendment from 2019, which suggests that clinicians should perform a post-void residual assessment prior to surgical intervention for LUTS/BPH 1. The elevated creatinine in this patient suggests possible obstructive uropathy from BPH, which can lead to urinary retention and kidney injury. A post-void residual measurement will directly assess if the patient has significant urinary retention causing the renal dysfunction.
Key Considerations
- The patient's elevated creatinine level indicates potential kidney injury, which could be due to obstructive uropathy caused by BPH.
- A post-void residual volume check is a straightforward and cost-effective way to determine if urinary retention is contributing to the renal dysfunction.
- While an ultrasound could provide additional information, such as prostate size and shape, it is not the first-line test in this scenario, as recommended by the 2019 AUA guideline amendment 1.
- The presence of significant residual urine (typically >100 mL) would confirm urinary obstruction as the likely cause of the elevated creatinine, guiding further management decisions.
Management Implications
- If significant residual urine is found, this would support the need for interventions aimed at relieving the obstruction, such as catheterization or surgical intervention for the BPH.
- The elevated glucose level, suggesting possible diabetes, should be addressed separately but does not take precedence over assessing and managing the potential obstructive uropathy given the elevated creatinine.
- The choice of subsequent diagnostic tests or therapeutic interventions should be guided by the results of the post-void residual volume check and the patient's overall clinical presentation, as outlined in the AUA guidelines 1.
From the Research
Neurogenic Bladder Assessment for BPH Patient
The patient in question has Benign Prostatic Hyperplasia (BPH), impaired renal function (Creatinine 1.6), and hyperglycemia (Glucose 212). When considering the next best step for Neurogenic Bladder (NBS) assessment, the options are:
- Post-void residual volume check
- Ultrasound
Post-void Residual Volume Check
According to the study 2, measurement of post-void residual urine is recommended in guidelines and recommendations on the management of LUTS and urinary incontinence. The interval between voiding and post-void residual (PVR) measurement should be of short duration.
- The study 3 suggests that a large post-void residual urinary volume may be related to the development of urinary tract infection, with a cutoff value of 180 ml placing adult men at risk for bacteriuria.
- Another study 4 compared two techniques used to assess adequate postoperative bladder emptying and found that the back fill technique correlated better with a successful voiding trial than the auto fill trial.
Ultrasound
The study 2 also mentions that ultrasound bladder volume measurement is preferred to urethral catheterization for measuring post-void residual urine.
- However, there is no direct evidence in the provided studies to suggest that ultrasound is the next best step for NBS assessment in this specific patient.
- The patient's condition, including BPH, impaired renal function, and hyperglycemia, should be considered when deciding on the best approach for NBS assessment.
Considerations
The patient's BPH condition is relevant, as studies 5 and 6 discuss the treatment and management of BPH, including the use of 5-alpha reductase inhibitors.
- However, these studies do not directly address the question of NBS assessment.
- The patient's impaired renal function and hyperglycemia should also be taken into account when considering the best approach for NBS assessment.