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OBJECTIVE The aim of this study was to determine the risk factors for catheter use and incomplete bladder emptying (IE) more than 1 week after prolapse repairs and slings. METHODS This is a case-control study of women with prolapse repairs and/or sling from June 2011 to April 2016. All underwent standardized postoperative voiding trial before discharge. Controls and cases of IE were identified by codes and chart review; cases were defined as those needing any postoperative catheterization. We excluded patients with preoperative catheter use or postvoid residual (PVR) greater than 150 mL and those needing postoperative catheterization for reasons other than IE. Univariate and multivariate analyses were performed. RESULTS A total of 475 (30.6%) cases and 478 controls were identified from 1552 eligible patients. Any catheter use was associated with higher uroflow PVR (71.2 vs 54.1 mL, P = 0.006), lower uroflow maximum flow (19.4 vs 25.4 mL/s, P < 0.001), and less detrusor overactivity (DO) (22.0% vs 28.7%, P = 0.03). Seventy-seven (5.0%) patients used catheters more than 1 week, and 15 patients (1.5%) required sling revision.Factors on multivariate analysis associated with any catheter use include office PVR [odds ratio (OR), 1.004; 1.00-1.008], uroflow maximum flow (OR, 0.96; 0.94-0.98), sling (OR, 2.40; 1.51-3.81), and anterior repair (OR, 1.81; 1.15-2.85). Factors associated with IE more than 1 week include uroflow maximum flow (OR, 0.90; 0.84-0.95), DO (OR, 0.21; 0.05-0.83), sling (OR, 3.68; 1.32-10.20), and uterosacral suspensions (OR, 3.43; 1.23-9.54). CONCLUSIONS Overall, the incidence of short-term catheter use was 31%, prolonged IE more than 1 week was 5%, and 1.5% required sling revision. Sling placement, lower maximum flow, and higher preoperative PVR, anterior repair, and uterosacral ligament suspension are risk factors for IE, and presence of DO is protective.

Introduction and hypothesis Covert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery. Methods After the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV

Lower urinary tract symptoms are bothersome and significantly impair patient's quality of life. Incomplete bladder emptying affects both men and women, and has shown to increase in incidence with aging. Incomplete bladder emptying is consequent upon an inability of the detrusor muscle to adequately contract to completely empty the bladder, with or without an increased bladder outlet resistance; this can be defined urodynamically as detrusor underactivity (DUA). The symptom complex consequent upon DUA is referred to as underactive bladder (UAB). Although the occurrence of DUA increases with age, and is commonly encountered in clinical practice, it is a largely unrecognized and consequently under researched condition.In this article, we will highlight the importance of DUA. We will review UAB as currently defined, the symptoms of DUA, its epidemiology, and etiopathogenesis, risk factors for developing DUA, and methods of diagnosis with an up-to-date review of the contemporary literature.DUA and its associated symptoms and signs are still poorly recognized entities. Difficulty and confusion arise in properly diagnosing DUA, as at present it can only be accurately defined on the basis of pressure flow urodynamics. Current attention is focused on validating a satisfactory definition for the syndrome complex of UAB.

Pelvic organ prolapse (POP) can cause incomplete bladder emptying or hydronephrosis and renal failure. These are serious conditions, especially in elderly women, requiring resolution of POP. Pessary use is an alternative, but there are specific problems or patients may not want it. We therefore conducted a retrospective study on surgical treatment of elderly women with respect to the type of surgery and intra- and postoperative complications.From two urogynecologic centers, we reviewed treatment data between 2003 and 2013, including patients ≥80 years of age. From the hospital records, intra- and postoperative data were extracted.91 cases met the inclusion criteria. Mean age was 84.38 years (±3.05, max 92 years). Two patients (2.2%) were diagnosed with hydronephrosis and two with urosepsis/renal failure. The mean length of surgery was 81 min (±45 min, range 10-270), 94.5% of patients were under general anesthesia. Two bowel lesions occurred. The mean length of hospital stay was 8 days (range 1-22, n = 90). There were no perioperative mortalities. Six patients (6.6%) were admitted to intensive care unit.In the future, we will be facing a growing number of elderly women seeking care for POP. In our retrospective analysis, we were able to show that POP surgery could be performed safely. We therefore consider surgical treatment as a valuable alternative if pessary use is not an option.

INTRODUCTION AND OBJECTIVES:Urinary retention is a significant adverse event after surgery which predisposes patients to increased hospital stay and avoidable returns to the Emergency Department. T...

Underactive bladder (UAB) is characterized by prolonged voiding, hesitancy, and slow and/or intermittent stream with or without a sensation of incomplete bladder emptying. The overlap of UAB lower urinary tract symptoms with those of overactive bladder or bladder outlet obstruction, as well as its multifactorial etiology, make UAB study, as well as its diagnosis and management, a very arduous and challenging task. Therefore, despite its incidence and significant impact in the quality of life of both men and women, UAB remains a poorly understood urologic condition with insufficient and ineffective treatment options available. In this review, we will focus on the etiology theories that have been proposed and the animal models available to test those theories.

The physiology of voiding is intricate and complex, and there is vast potential for disruption of normal voiding patterns. For adequate bladder emptying to take place, the bladder needs to generate a pressure of adequate strength and duration to overcome the resistance set by the outlet. Disruption in the generation of the bladder pressure required, or of the outlet to allow passage of urine, will result in incomplete bladder emptying. Underlying these pathophysiological processes is the gateway for proper development of new therapies. It is important to have a solid knowledge of terminology applied to the genitourinary tract for purposes of reporting results and developing treatment guidelines.

Objective To investigate lower urinary tract dysfunction in pre-toilet trained infants with and without history of febrile UTI (f-UTI). Materials and Methods Pre-toilet trained infants with f-UTI (Group 1) from pediatric nephrology and urology clinics, and those without f-UTI (Group 2) from infant-care centers were enrolled for the present study. Infants in Group 1 underwent four-hourly (4-H) observations for at least one month after treatment for UTI. Voided volume (VV) and post-void residual urine (PVR) were measured by weighting diaper and suprapubic ultrasound after finishing voiding, respectively. Average PVR was defined as the mean value of PVR during 4-H observation. Interrupted voiding was defined as two or three voidings within 10 min. Voiding efficiency was defined as VV/(VV + PVR). Results The mean ages of Group 1 ( n = 64) and Group 2 infants ( n = 56) were 10.6 ± 7.5 months vs 10.2 ± 5.1 months, respectively ( p = 0.70). Group 1 infants had significantly higher voiding frequency (3.0times ± 1.2 vs 2.6times ± 0.9, p = 0.04), average PVR (14.5 ml ± 14.2 vs 8.9 ml ± 8.8, p p = 0.01) than Group 2. ROC curve analysis showed that the optimal cutoff values for PVR and voiding efficiency to differentiate Group 1 and Group 2 infants were 10 ml and 80%, respectively. Group 1 infants had significantly more repeat elevated PVR (≧ 10 ml) and repeat low voiding efficiency (≦ 80%) than Group 2 (44.8% vs 22.4%, p = 0.03; 62.0% vs 28.6%, p Conclusion Pre-toilet trained infants with f-UTI were associated with elevated PVR and lower voiding efficiency than normal controls.

Catheters are a common method of bladder drainage for obstructive voiding or incomplete bladder emptying. Presuming that a clinical rationale has been proven identifying that a Foley catheter has been assessed as the best method for bladder drainage, this chapter will identify evidence-based practical ideas to support management of the problematic indwelling catheter. This includes explanations and solutions to catheter-associated UTI (CAUTI), bypassing and expelled catheters, the non-draining catheter including catheter encrustation, pain associated with catheters and general problems associated with catheter insertion and removal. Practice that is advised and not advised is detailed.

Purpose To investigate the association between constipation and the results of uroflowmetry with post-void residual urine (PVR) tests in healthy children. Materials and Methods We enrolled healthy children aged between 4 and 12 years for evaluation of voiding and defecation function. A parent of children completed the questionnaire, and the children were asked to do uroflowmetry and PVR. Constipation is defined as defecation frequency ≤2 times/week or type 1–2 stool forms on Bristol stool scale. Uroflowmetry curve and PVR were eligible for analysis if voided volume was between 50 ml and expected capacity for age. Results Totally, 778 children (415 boys and 363 girls) with a mean age of 7.2 ± 2.2 years were eligible for analysis. The prevalence of constipation was 10.9% by low defecation frequency, and 28.4% by Bristol stool scale, respectively. Regarding the rate of constipation, there were no statistically significant differences between genders. Compared to children without low defecation frequency, constipated children had higher PVR (9.0 vs. 5.9 ml, P = 0.01), higher rate of PVR > 20 ml (17.7% vs. 7.1%, P = 0.01) and lower voiding efficiency (93.2% vs. 94.9%, P = 0.04). Compared to children without type 1–2 Bristol stool, constipated children did not have higher PVR (7.2 ml vs. 5.8 ml, P = 0.10), nor lower voiding efficiency (94.0% vs. 95.0%, P = 0.11). Urgency symptom score and rate of abnormal flow patterns were comparable between children with or without constipation. Conclusion Constipation defined as low defecation frequency was associated with incomplete bladder emptying in healthy children. Neurourol. Urodynam. 31:105–108, 2012. © 2011 Wiley Periodicals, Inc.

To determine the value of pre-operative teaching of clean intermittent self-catheterisation (CISC) in women who undergo anti-incontinence and/or prolapse surgery and who are at ‘high risk’ to have post-operative incomplete bladder emptying. Out of the 402 patients who underwent anti-incontinence and/or prolapse surgery at our institute (March 2008–March 2009), 48 patients had at least one obstructive lower urinary tract symptom and one obstructive urodynamic parameter before surgery and were considered at ‘high risk’ to have post-operative incomplete bladder emptying. They were taught CISC pre-operatively. Out of the 48 patients, 7 (14.6%) had incomplete bladder emptying. The incidence of post-operative incomplete bladder emptying was higher in the older women (P

This paper reviews the evidence on incomplete bladder emptying in frail older adults. It argues the case for interpreting the clinical significance of postvoid residual urine in this group of individuals with caution and in context to avoid either under- or overtreatment.

Menkes syndrome is a genetic disorder of copper metabolism, often with urologic complications, including bladder diverticula and vesicoureteral reflux. A 1-year-old boy with Menkes syndrome presented with recurrent urinary tract infections and incomplete bladder emptying secondary to 2 large bladder diverticula. He underwent robot-assisted excision of both diverticula with subsequent improved emptying and resolution of urinary tract infections. There is no consensus on management of bladder diverticula in Menkes syndrome. Because the life span of these patients is significantly shortened, one must select an intervention based on their clinical condition, potential morbidities, and informed expectations of the family.

Underactive bladder syndrome causes difficulty in voiding, resulting in incomplete bladder emptying. This article describes common causes of the condition, patient assessment and the available management options.

Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.

Introduction Visualization of a midurethral sling may be challenging intraoperatively, especially if the sling is deep, well healed, not in the usual location, or made of materials that are not colored. Case We present the case of a 71-year-old woman presenting with a history of incomplete bladder emptying and debilitating voiding dysfunction documented by uroflowmetry and postvoid residual after a tension-free vaginal tape placement. Medications in addition to attempts to dilate her urethra failed to provide her with adequate relief. Intraoperative 3-dimensional ultrasound guidance was used to transect the sling that was otherwise unable to be localized with examination alone. Conclusions Surgical transection of a tension-free vaginal tape can be safely performed under the guidance of ultrasound. At her 12-month follow-up visit, the patient did not have urinary incontinence or voiding dysfunction.

Incomplete bladder emptying or dysfunctional voiding is a common lower urinary tract dysfunction encountered in children. Alpha blocker therapy is used to facilitate bladder emptying in the adult population and has likewise been applied to the pediatric population. Alpha blocker therapy seems well tolerated in children and appears efficacious towards improving bladder emptying in a variety of pediatric voiding disorders. Long-term follow-up and further investigation are warranted in order to validate the role of alpha blocker therapy in pediatric dysfunctional voiding.

Patient performance of clean intermittent self-catheterization is a crucial component of the management of incomplete bladder emptying, which can arise from a variety of conditions. This allows patients to have more control over their bladder emptying, and avoids the inconveniences that come with an indwelling urethral catheter. There are, however, barriers that patients face when performing this task which may ultimately limit adherence. In this article, these barriers are discussed in more detail with potential solutions to counter them., Video abstract

Study design: A field study was conducted in 40 patients with multiple sclerosis (MS) by comparing their residual urine volumes with the Kurtzke Functional Systems Scales for pyramidal (PFS) or bladder functions (BFS). Objectives: To determine whether raised residual urine volumes necessitating intermittent self catheterisation can be predicted by the PFS or BFS. Setting: Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals Trust, London, UK. Methods: In 40 patients with MS, post micturition residual volumes were measured with ultrasound prior to any treatment of bladder dysfunction. The patients' symptoms were assessed using PFS and BFS. Correlation between PFS, BFS and post micturition residual volumes were calculated as were sensitivity and specificity of PFS and BFS in predicting incomplete bladder emptying with residuals above 100 ml. Results: None of the patients with a PFS or BFS of 0 or 1 had a residual of more than 100 ml. There was a linear progression of maximal residuals with PFS and BFS. Correlation between PFS (BFS) and the post micturition residual volumes was 0.37 (0.71). Conclusion: Unless a patient with MS has a PFS or BFS of greater than 1 they are unlikely to have incomplete bladder emptying with post micturition residual volumes above 100 ml. With PFS of BFS greater than 1 measurement of the post voiding residual volume is mandatory.

Two Imerslund-Grasbeck patients who presented with recurrent urinary tract infections and genitourinary abnormalities are described. The patients were evaluated with abdominal ultrasounds, voiding cystourethrograms, and Schilling tests. Each patient had large postvoid residual urine secondary to a motor-neurogenic bladder. One had a duplication of the distal urethra manifesting as two meatal openings. There was lack of urinary excretion of radioactive vitamin B12 on Schilling tests in both patients. Patients with Imerslund-Grasbeck syndrome may be predisposed to urinary tract infections because of incomplete bladder emptying. Complete physical and radiological examinations of the genitourinary tract should be performed.

Urinary incontinence, a common and troublesome manifestation of voiding dysfunction in the elderly, must be viewed as a single symptom within the spectrum of bladder dysfunction. Other symptoms of such dysfunction include urgency, increased urinary frequency, nocturia, slow stream, hesitancy, feeling of incomplete bladder emptying, etc. Abnormalities in the voiding cycle may range from those that simply annoy patients to the severe and disabling.

An 81-year-old woman presented with uterine procedentia and incomplete bladder emptying. She initially experienced significant relief of her symptoms with a pessary but developed chronic vaginal bleeding and discharge. She subsequently underwent a LeFort colpocleisis. She presented to the office 7 weeks later complaining of a persistent vaginal discharge and loss of appetite. She was admitted to the hospital and was diagnosed with a pyometra and underwent a supracervical hysterectomy without complications.

Assessment of symptoms plays a central role in the evaluation of men with suspected bladder-outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). It is on the basis of symptoms that treatment designed to relieve outflow obstruction is recommended. However, a variety of studies have suggested that a considerable proportion of men presenting with suspected outflow obstruction are not obstructed as determined by pressure-flow criteria. The relationship between many so-called "obstructive" symptoms and BOO has not yet been defined. Furthermore, all previous studies have defined BOO on the basis of urethral resistance factors, which are now regarded as outdated. Using current concepts of urethral pressure-flow relationships, we studied in detail the relationship between the "obstructive" symptoms of BPH, objective evidence of abnormal voiding and BOO. Only the symptoms of hesitancy and poor flow were found to be significantly related to BOO. The symptoms of straining to void, intermittency, terminal dribbling and feeling of incomplete bladder emptying were not specific for BOO. Objective evidence of an intermittent flow pattern and of terminal dribbling do, however, have a high specificity and positive predictive value for BOO. The assessment of men with lower-urinary-tract symptoms must include objective tests of voiding function. A better understanding of the pathophysiology of lower-urinary-tract symptoms should lead to an improved symptomatic outcome of prostatectomy.

Kuo-Wei Yu,1,* Chien-Lin Lin,1,2 Chun-Chuang Hung,3 Eric Chieh-Lung Chou,4 Yueh-Ling Hsieh,5 Te-Mao Li,2,3,* Li-Wei Chou1,2,61Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 2School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 3Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan; 4Department of Urology, China Medical University Hospital, Taichung, Taiwan; 5Department of Physical Therapy, China Medical University, Taichung, Taiwan; 6Acupuncture Research Center, China Medical University, Taichung, Taiwan*These authors contributed equally to this workBackground: Incomplete bladder emptying (IBE) is defined as having a postvoid residual (PVR) urine volume greater than 100 mL for 2 consecutive days. IBE is common in stroke patients and could necessitate indwelling or intermittent catheterization. The condition is correlated with urinary tract infections, which could impede rehabilitation progress and increase medical costs. Treatment for patients with IBE includes bladder retraining, biofeedback, medication, and botulinum toxin injection, but none of these interventions are completely effective.Methods: All patients with acute stroke who were admitted to the rehabilitation ward between August 2010 and April 2011 were included in the study and their PVR urine volume was checked. Electroacupuncture (EA; 1 Hz, 15 minutes) was performed on the acupoints Sanyinjiao (SP6), Ciliao (BL32), and Pangguangshu (BL28) of stroke patients with IBE for a total of ten treatments (five times a week for 2 weeks). Bladder diaries, which included the spontaneous voiding and PVR urine volumes, were recorded during the course of treatment.Results: The presence of IBE was not related to sex, history of diabetes mellitus, stroke type (hemorrhagic or ischemic), or stroke location (P > 0.05). Among the 49 patients in the study, nine (18%) had IBE, and seven of the stroke patients with IBE were treated with EA. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of EA.Conclusion: EA may have beneficial effects on stroke survivors with IBE, thereby making it a potential safe modality with which to improve urinary function.Keywords: acupuncture, electroacupuncture, incomplete bladder emptying, rehabilitation, stroke, urinary retention

Purpose The voiding of healthy newborn boys shortly after term is dominated by dyscoordinated flow patterns (Olsen et al. J Urol in press) and continues to do so during the first year of life (Olsen et al. J Ped Urol 2008). This study addresses the flow patterns of premature boys. Material and Methods The parents of 29 otherwise healthy premature males accepted to let their child participate in the study. Flow measurements were carried out using an ultrasound flow probe device during a 4-hour observation period. Flow patterns were assessed according to the definitions of the ICCS. Data of 25 boys (median gestational age/weight at birth: 31.3 weeks/1590 g) with 98 micturitions where applicable for analysis. Results are reported as median (range). Results On examination median age was 10 (3-42) days. Flow patterns were bell-shaped in 48%, interrupted in 44%, staccato in 6% and plateau in 2%. In nine of the 47 bell-shaped curves (19%) some fluctuations occurred though not fulfilling the criteria of staccato. None of the premies with more than one recorded micturition had bell-shaped curves only. The number of coordinated flows was not correlated to the age (r2 0.016, P = 0.6). Subjects voided 0.7 (0.2-3.6) times/hour with a volume of 3.9 (0.6-25.2) mL. Median Qmax was 1.0 (0.3-10.0) mL/s. Conclusions Male premies void with a high degree of dyscoordination, small volumes and Qmax values indicating incomplete bladder emptying. Dyscoordinated voiding seems to be part of the natural development of voiding function. This study supports the observations made in mature newborns and during infancy showing maturational voiding coordination.

Menkes’ syndrome, a rare sex-linked disorder of copper metabolism, has been found to be associated with a high incidence of urologic abnormalities. Bladder diverticula were present in 3 of the 4 patients reviewed. Management of incomplete bladder emptying and consequent urinary tract infection is discussed.

In most recent series of artificial sphincter implantations there has been a reduction in mechanical and surgical complications, with continence rates approaching 90 per cent. Despite initially excellent results in 47 children, with increasing durations of followup we noted a transient hydronephrosis related to incomplete bladder emptying in 5 and a persistent physiological alteration of detrusor dynamics consisting of a rigid, noncompliant bladder in 7. Preoperatively, all patients had had in-depth radiological studies and most had a urodynamic evaluation, and were considered to be excellent candidates. The etiology of these alterations is not understood at this time. Bladder and even upper tract deterioration can occur without the appearance of urinary leakage. Therefore, children with an artificial sphincter must be monitored indefinitely with semiannual assessment of the upper tracts and periodic urodynamic evaluation.

Acute urinary retention and overflow incontinence in an older male patient indicate infravesical obstruction by prostatic hypertrophy. Nocturia, frequency, small voided volumes, weak stream, hesitancy, prolonged voiding time, pain, urgency, urge incontinence, postvoiding dribble, and the feeling of incomplete bladder emptying are the symptoms of “prostatism” attributed to chronic urethral obstruction.

Fifty-one patients undergoing abdominoperineal resection of the rectum for carcinoma were studied with regard to bladder function after surgery. Fifty-nine per cent had motor denervation of the bladder due to tumour or operative damage to the pelvic parasympathetic nerves and this produced symptoms of incomplete bladder emptying requiring treatment in 90% of this group. The factors affecting the incidence of nerve damage were discussed. The long-term effect of parasympathetic nerve damage was investigated and the management is discussed.