Evaluation of post-void residual urine and functional outcomes in healty young volunteers

Abstract

Introduction and aim of the study: Post\u2010void residual (PVR) urine is a debated part in the assessment of patients with lower urinary tract symptoms (LUTS) due to its not standardized threshold. Aim of this study was to measure PVR in young and healthy males and females. Materials and methods: This is an observational prospective multicenter ongoing study started on January 2018, involving volunteers both men and women with age 18 to 35 years. Medical history was recorded. Volunteers were asked to perform a uroflowmetry (UF) whit a normal micturition desire. A VAS scale was marked by each volunteer indicating the subjective evaluation of the voiding at UF compared to the habitual micturition at home. Peak\u2010flow (Qmax), voided volume and the curve of the UF were registered. PVR was measured immediately after the UF with a bladder scan. PVR\u2010ratio, as the ratio of PVR to bladder volume (BV: voided volume + PVR) was also calculated. Males filled the International Prostate Symptoms Score (IPPS) questionnaire, while women both W\u2010IPSS and ICIQ\u2010FLUTS. Population was also divided according with IPSS/WIPSS severity scores: (i) 0 to 7; (ii) 8 to 19; (iii) 20 to 39. UF data were also plotted on Liverpool nomograms. Statistical analysis was performed using T test and Mann\u2010Whitney test. Exclusion criteria were: urological and neurological diseases, surgery of the urinary tract or the pelvis or genitalia, pharmacological therapies, previous urethral catheterization, radiation therapy of the pelvis. Informed consent was obtained by all the volunteers. Results: A total amount of 114 volunteers were enrolled, 45.6% (n 52) males and 54.4% (n 62) females. Mean age was 26 years.o. (18\u201035). Table 1 reports data on Qmax, PVR, PVR \u2010ratio IPSS/WIPSS of the population. Mean ICIQ\u2010FLUTS score was 2.8 \ub1 3.9, and the median 2 (1\u20103). According to IPSS\u2010WIPSS scores 98.2% (n 110/112) of the volunteers reported a score <8, and 2 males (1.8%) referred an IPSS score between 8 and 19. VAS scale of the subjective evaluation of voiding was <6 in 5.3% (n 6/114) of the population. Table 2 reports outcomes according to Liverpool nomograms. A PVR of 0mL was found in 60.5% of the population (69/114), in 63% of the males (34/54) and in 56.4% of the females (35/62). A PVR>50 ml was found in 12.3% of the cohort (14/114): 7.7% of males (4/52%) and 16.1% (10/62). A PVR\u2010ratio >10% was found in 21% of the volunteers (24/114), in 17.3% in males (9/52) and 24.2% in females (15/62). Interpretation of results: In a young and healthy population with regular UF parameters only 60% had no PVR, while 1/10 volunteers showed a PVR >50ml, with a double rate in female volunteers. PVR \u2010ratio was found two times higher in females. The PVR\u2010ratio >10% was present in 1/5 volunteer, and more common in females.Although our population reported no lower urinary tract symptoms at the medical history, with normal symptom scores, surprisingly 17% of the volunteers showed an abnormal score at the Liverpool nomograms. Volunteers of this subgroup showed significantly lower Qmax without significant difference in PVR volumes. This data may indicate that PVR could be a poor reliable parameter of pathological bladder emptying. Conclusions: In a non\u2010negligible part of young and healthy population a PVR was documented. In females PVR wasamorefrequentfindingwithvolumestwotimeshigher. Liverpool nomograms evaluation recognized a significant part of the volunteers as pathological. This group had a significant lower Qmax, but no significant higher PVR. This data may confirm the controversial role of PVR in the evaluation of patients with voiding dysfunction