Is a post-void residual (PVR) of 27 milliliters (mL) normal for a 10-year-old?

Post-Void Residual of 27 cc in a 10-Year-Old

A post-void residual (PVR) of 27 cc is within normal limits for a 10-year-old child, as it falls below the threshold of concern established for pediatric patients. 1

Normal PVR Values in Children

• PVR measurements in children show significant variability, requiring repeat measurements for accurate assessment 2, 3
• For children, a PVR greater than 20 ml on repeated measurements (without bladder overdistention) is considered abnormal 3
• In healthy kindergarteners, the mean PVR was found to be 12.2 ml with a standard deviation of 20.3 ml, making 27 cc slightly elevated but not necessarily abnormal 3
• Intra-individual variability is high, so a single PVR measurement is not reliable for assessing pediatric voiding function 3

Assessment Recommendations

• For confirmation of any abnormal findings, PVR measurement should be repeated up to 3 times in the same setting in a well-hydrated child to ensure reliable results 2, 1
• Measurements should be taken within 5 minutes after voiding when voided volume is greater than 50 ml for accuracy 3
• PVR is affected by bladder overdistention, age of the child, and possibly extra hydration before assessment 3

Clinical Significance of PVR in Children

• PVR increases with age and varies by gender, suggesting that age-specific reference values should be used 4
• In adolescents, PVR >20 ml (7% of bladder volume) for males and >25-35 ml (9-10% of bladder volume) for females warrants monitoring 4
• Elevated PVR is a risk factor for urinary tract infections and can predict treatment outcomes in vesicoureteral reflux, pediatric enuresis, and non-neurogenic lower urinary tract dysfunction 4

Management Considerations

• If the child has symptoms of dysfunctional voiding (such as urinary incontinence, urgency, or recurrent UTIs), even a borderline PVR may warrant attention 5
• Treatment of associated constipation alone has been shown to improve bladder emptying in 66% of children with increased PVR 1
• For children with consistently elevated PVR and symptoms, techniques such as double voiding (several toilet visits in close succession) may be recommended, particularly in the morning and at night 2
• Regular monitoring with voiding charts, uroflowmetry, and PVR measurement is necessary for children with dysfunctional voiding 1

Common Pitfalls to Avoid

• Relying on a single PVR measurement can lead to misdiagnosis due to high intra-individual variability 3
• Failing to account for bladder overdistention can result in falsely elevated PVR values 3
• Not considering associated conditions like constipation that may contribute to elevated PVR 2
• Overlooking the need to assess bowel function in children with borderline or elevated PVR, as treating constipation can resolve bladder emptying issues 2, 1

In conclusion, while 27 cc is within normal limits for a 10-year-old, if there are accompanying symptoms of lower urinary tract dysfunction, further evaluation with repeated measurements and assessment of bowel function would be appropriate.