Importance of Post-Void Residual Volume Measurement in Treating Men and Women with Urinary Problems
by Dr. Alex Shteynshlyuger, a board-certified urologist, and specialist in the treatment of urinary problems in men and women including frequent urination, burning with urination and urinary retention.
Post-Void Residual Urine: What You Need to Know
What is Post-Void Residual Volume Measurement?
Post-void residual volume refers to the amount of urine left in the urinary bladder after urination. Postvoid residual (PVR) volume measurement is an important component of urological care. It is one of the most useful tests for urologists treating urinary problems.
PVR measurement can help urologists determine whether the urinary problem is caused by incomplete bladder emptying or urinary retention related to symptoms of overactive bladder. This helps in guiding initial therapy and it is also a very useful test for monitoring of treatment in patients with incomplete bladder emptying.
What is the Normal Post Void Residual Volume?
Ideally, the postvoid residual volume should be very close to 0. However, this is partially determined by the degree of bladder distention. In patients who over-distend their bladder, the PVR may be elevated compared to when they void with a normally distended bladder.
In general, in young men and women, the PVR should be less than 20-30 mL. As men get older, prostatic obstruction (which typically occurs somewhere between the ages of 40 and 50) can cause incomplete bladder emptying. As long as the patient is minimally symptomatic, a PVR of up to 50 mL may be considered reasonable.
Certainly, when the postvoid residual is greater than 75-100 mL, most patients become symptomatic as they are probably only emptying two-thirds of their bladder (for example, if the capacity is 300 mL). As a result, the patient has to run to the bathroom quite often because the bladder will be filling up faster.
What Problems Does High Post-Void Residual Cause?
A high PVR may predispose both men and women to urinary tract infections. It can also lead to frequent urination as the bladder is never completely empty and as a result, it fills up faster.
Many patients also feel an uncomfortable sensation of incomplete bladder emptying after they urinate. This makes them run to the bathroom shortly after they urinate to try to double void. They may also need to strain to empty the bladder.
Occasionally, incomplete bladder emptying and urinary retention can lead to acute renal failure, a life-threatening condition.
Diagnosis of Elevated Post-Void Residual at New York Urology Specialists
Our specialists are experienced in treating men and women with urinary problems, including high post void residual. The first step is to do a thorough evaluation to determine the underlying cause of the problem. In addition to a detailed history, the urologist may order laboratory tests such as urinalysis, blood glucose, and prostate-specific antigen. Typically, studies such as pelvic ultrasound with PVR and uroflow studies are used. Cystoscopy and urodynamic studies may be useful to help determine the cause of the problem as well as for treatment planning. Because a diverse number of problems can cause elevated postvoid residual, the treatment is determined by the underlying cause. Some of the common causes of incomplete bladder emptying include:
- Enlarged prostate
- Prostatic abscess
- Penile trauma
- Prostate cancer
- Pelvic organ prolapse
- Pelvic mass
- Vaginal infections
- Postpartum complications
In Both Men and Women
- Multiple sclerosis
- Urethral stricture
- Atonic bladder (nonfunctioning bladder muscle)
- Bladder diverticuli
- Constipation or fecal impaction
- Diabetes (diabetic neuropathy)
- Bladder cancer
- Bladder stones
- Gastrointestinal malignancy
- Neurogenic bladder
- Pelvic trauma
It is worth noting that certain medications can lead to incomplete emptying and retention of urine. These include anticholinergics, antiarrhythmics, antidepressants, antihistamines, antihypertensives, hormonal agents, anti-Parkinson drugs, antipsychotics, alpha-adrenergic, and beta-adrenergic agents.
Treatment Options for Elevated Postvoid Residual Volume in Women
It is important to identify the underlying reason for urine remaining in the bladder. In women, a high PVR may be caused by severe constipation, large fibroid uterus, or pelvic mass. It can also be caused by pelvic organ prolapse. Treatment of the underlying problem can often solve the issue of incomplete bladder emptying. In women who have a poorly functioning bladder and resultant retention of urine or incomplete bladder emptying, InterStim treatment may be beneficial. Urinary self-catheterization is another option for treatment of elevated PVR.
Treatment of High Post-Void Residual Volume in Men
The most common causes of elevated PVR in men are enlarged prostate and urethral strictures. Treatment of enlarged prostate with medications, office procedures such as Rezum or UroLift, or surgery such as prostate enucleation or TURP can often improve or resolve the problem of retained urine in the bladder.
Occasionally, an elevated postvoid may be caused by prostate cancer or bladder cancer leading to incomplete bladder emptying and urinary retention. Colon and rectal cancer can also occasionally cause urinary problems.
Why Choose New York Urology Specialists for Treatment of Elevated Post-void residual?
- All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of frequent urination, urinary urgency, urinary incontinence and bladder pain using medical therapy, minimally invasive therapies, lasers, and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of urinary problems in men and women
- We offer treatment options for overactive bladder, UTI, and urinary incontinence in our office which avoids the risks, costs, and recovery from general anesthesia.
- Extensive Experience: Hundreds of men and women have treated successfully using medical therapy, Botox for overactive bladder, Interstim for frequent urination and tibial neuromodulation.
When it comes to experience and innovation – New York Urology Specialists are a step ahead. Better Science Means Better Care. We specialize in minimally invasive highly effective treatment for symptoms of bladder pain, urethral burning, pelvic discomfort, incomplete bladder emptying, urinary frequency, and urgency. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.
Medicare and major insurances accepted. We offer affordable rates and financing options.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems. He uses modern effective and proven treatment methods including Botox for OAB, Interstim neuromodulation. He is highly recommended by top primary care physicians in the New York area.
He has successfully treated hundreds of men and women of all ages with urinary problems including bladder problems, kidney problems, urethral and ureteral problems.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men and women with urinary problems including frequent urination, difficulty emptying the bladder, urinary urgency and incontinence.