Is a post-voiding residual volume of 73 mL with no other abnormalities considered normal and what are the next steps?

Management of Post-Void Residual Volume of 73 mL

A post-void residual (PVR) volume of 73 mL is within normal limits and does not require immediate intervention, but warrants follow-up monitoring due to being in the low-risk range (60-100 mL). 1

Interpretation of Current Findings

• PVR of 73 mL falls within the 60-100 mL range, which the American Urological Association considers low risk for complications 1
• Pre-voiding volume of 484 mL indicates normal bladder capacity
• Wall thickness of 0.3 cm is within normal limits
• Absence of focal lesions or echogenic calculi rules out anatomical causes of obstruction

Recommended Next Steps

1. Clinical Assessment

• Complete an evaluation of lower urinary tract symptoms using validated questionnaires:
  • International Prostate Symptom Score (I-PSS) to assess symptom severity 2
  • BPH Impact Index to evaluate impact on quality of life 2
  • Frequency-volume chart (FVC) to document voiding patterns 2

2. Flow Rate Measurement

• Obtain at least 2 uroflowmetry measurements with voided volumes >150 mL each 2
• Maximum flow rate (Qmax) is the most valuable parameter:
  • Qmax <10 mL/second suggests bladder outlet obstruction 2
  • Qmax >10 mL/second with symptoms may require pressure-flow studies 2

3. Follow-up PVR Measurement

• Repeat PVR measurement in 4-12 weeks to establish consistency 1
• If PVR remains stable or decreases, continue annual monitoring 2
• If PVR increases to >100 mL on 3 consecutive measurements, consider:
  • More frequent monitoring
  • Potential intervention 1

4. Lifestyle Modifications

• Implement regular voiding schedules
• Practice double voiding techniques (attempting to void again after initial void)
• Ensure proper toilet posture
• Address any constipation issues 1

When to Consider Additional Evaluation

Urodynamic Studies

• Consider if:
  • PVR increases over time
  • Patient develops new or worsening lower urinary tract symptoms
  • Need to differentiate between detrusor underactivity and bladder outlet obstruction 1

Specialist Referral

• Refer to urologist if:
  • PVR increases to >200 mL
  • Patient develops symptoms of urinary retention
  • Upper urinary tract changes are detected on follow-up imaging 1

Important Considerations

• A single PVR measurement has limited value due to significant intra-individual variability 2
• PVR should be interpreted in the context of symptoms and other clinical findings 1
• Detrusor underactivity may contribute to elevated PVR even with normal prostate size, especially in older patients 1
• Monitor for signs of urinary tract infection, which is more common in patients with elevated PVR 1

Pitfalls to Avoid

• Don't overtreat a mildly elevated PVR in the absence of symptoms
• Don't rely on a single PVR measurement for clinical decisions due to variability
• Don't assume bladder outlet obstruction is the only cause of elevated PVR; consider detrusor underactivity
• Don't initiate catheterization for PVR <100 mL unless clinically indicated 1