Symptom reports unreliable indicator of urinary retention

A study emanating from Loyola University Medical Center, Maywood, IL, indicates that urinary symptoms alone are insufficient to diagnose urinary retention.

"We noted that some women with symptoms did not have urine retention, and we also noted that some women without symptoms did have the problem. We decided to find out if we could rely on symptoms alone to diagnose retention," Lior Lowenstein, MD, who presented the study here, told Urology Times.

To resolve the question, Dr. Lowenstein, Kimberly Kenton, MD, and colleagues reviewed consecutive charts of 636 new patients entering the female urology clinic. Prior to first visit, all patients were asked to complete the short form of the Pelvic Floor Distress Inventory. Responses to questions 5, 6, and 19 were isolated.

"These three questions focus on urinary obstructive symptoms. We wanted to know if these constituted a good screening tool, one that might identify patients with urine retention," said Dr. Lowenstein.

Women who said they were "moderately" or "greatly" bothered on the first three questions relating to stress incontinence had post-void residual urine volumes that were 16 mL higher than were those of women who said they were not bothered. This was a statistical difference, but not a clinically significant difference between groups. Continuous post-void residual urine values did not correlate with stress scores or prolapse inventory scores.

"One might think that symptoms would most likely appear in those with pelvic organ prolapse, but we found that even in those with prolapse, the symptoms were not indicative of true urinary retention," Dr. Lowenstein said.

The authors concluded that neither the presence nor the magnitude of bother from obstructive urinary symptoms was sufficient to detect retention. Dr. Lowenstein said catheterization following spontaneous urination was a far more reliable approach to diagnosis.