Symptoms insufficient for urine retention diagnosis

Maywood, IL-A study from Loyola University Medical Center here posed a simple question: "Can a surgeon rely on obstructive symptoms to detect urinary retention?"

The study results, presented at the AUA annual meeting in Anaheim, CA, offered an equally simple answer: No.

"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," first author Lior Lowenstein, MD, a fellow in female pelvic medicine and reconstructive surgery at Loyola, told Urology Times. "We decided to find out whether we could rely on symptoms alone to diagnose retention."

Question 5 was: Do you usually experience a feeling of incomplete bladder emptiness? (If yes, how much does it bother you: not at all, somewhat, quite a bit?) Question 6 asked: Do you ever have to push up on the bulge in the vaginal area with your fingers to start or complete urination? (If yes, how much does it bother you: not at all, somewhat, quite a bit?) Finally, question 19 asked: Do you usually experience difficulty in emptying your bladder? (If yes, how much does it bother you: not at all, somewhat, quite a bit?)

"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," Dr. Lowenstein said.

None of the patients entering the study had a primary diagnosis of "urinary retention." Sixty percent of the cohort was found to have stage 0-I pelvic organ prolapse, 20% had stage II, and 20% had stage III-IV.

Urinary distress scores for 31 women with retention were 32±24. The scores for women without retention were 36±27. Similarly, the pelvic organ prolapse distress inventory scores for women were 29±21 for women with retention and 28±23 for those without retention.

The researchers noted that 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 they were in women who said they were not bothered. This was a statistical difference, but not a clinically significant difference, according to the authors. Continuous post-void residual urine values did not correlate with stress scores or with prolapse inventory scores.

Staging, PVR related

"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 explained.

Although prolapse appeared to be unrelated to symptoms, prolapse staging showed a strong relation to residual volumes. Women with stage III/IV prolapse had a greater mean post-void residual volume (67±92) than did those with stage II or lower (41±51; p<.001). Nearly half (48%) of the women with retention had stage III/IV prolapse, while only 21% of those without retention had stage III/IV prolapse.

In short, the study's authors concluded that neither the presence nor the magnitude of bother from obstructive urinary symptoms was sufficient to detect retention. Dr. Lowenstein suggested that catheterization following spontaneous urination was a far more reliable approach, and he added that "other etiologies need to be explored when retention is ruled out, but bothersome symptoms persist."