Normal Post-Void Residual Volume
A normal post-void residual (PVR) urine volume is generally considered to be less than 100 ml in adults, with values between 0-50 ml being optimal. 1
Definition and Normal Values
- The most recent research (2024) indicates that the 90th percentile of PVR for men is 73.2 ml (25% of bladder volume) and for women is 60.5 ml (21% of bladder volume), suggesting these as upper limits of normal 1
- The 95th percentile values are 102.6 ml (30% of bladder volume) for men and 93.8 ml (27% of bladder volume) for women 1
- Women typically have lower PVR volumes than men 1
- A PVR of 30 ml is considered a sign of adequate bladder emptying and normal voiding function 2
Clinical Significance of PVR Measurements
- PVR volumes greater than 200-300 ml are considered clinically significant and may indicate bladder dysfunction 3, 4
- Large PVR volumes (>200-300 ml) may predict a less favorable response to treatment for lower urinary tract symptoms 3
- PVR volumes of 350 ml or greater strongly indicate bladder dysfunction and may herald disease progression, particularly in benign prostatic hyperplasia (BPH) 3, 4
- No specific PVR "cut-point" has been established for clinical decision-making due to test-retest variability 3, 4
Measurement Techniques and Considerations
- Transabdominal ultrasonography is the preferred non-invasive method for determining PVR 4, 5
- Due to marked intra-individual variability, PVR measurement should be repeated to improve precision 6, 3, 4
- The interval between voiding and PVR measurement should be of short duration 5
- For confirmation of abnormal findings, PVR measurement should be repeated 3
Clinical Implications by Volume
- PVR volumes between 0-300 ml do not predict response to medical therapy for BPH 3, 4
- In patients with overactive bladder (OAB), caution should be used when performing botulinum toxin injection in patients with PVR >100-200 ml 3
- A PVR of 180 ml or greater has been associated with increased risk of bacteriuria in some studies, though this finding has not been consistently validated 7, 8
Important Considerations
- PVR can be affected by bladder volume - research shows PVR significantly increases when bladder volume is around 528 ml 1
- International Prostate Symptom Score (IPSS) correlates with PVR - higher scores are associated with higher PVR values 1
- Normal PVR does not exclude voiding dysfunction - studies show that patients with voiding dysfunction often have normal PVR values (even <50 ml) 9
- No level of residual urine, in and of itself, mandates invasive therapy for BPH 3, 4
When to Consider Further Evaluation
- PVR measurement is particularly helpful in patients with complex medical histories (e.g., neurologic diseases affecting bladder function) 3
- PVR should be measured prior to intradetrusor botulinum toxin therapy for OAB 3
- PVR should be obtained in OAB patients whose symptoms have not adequately improved or worsened after botulinum toxin injection 3