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Lower Urinary Tract Conditions

Lower Urinary Tract Conditions

Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters

Importance: Understanding the diagnostic accuracy of postoperative trial of void (TOV) parameters is important for decision making related to postoperative catheterization.

Objective: The aim of the study was to compare the diagnostic accuracies of common postoperative TOV parameters.

Design: The study population comprised a prospective cohort undergoing outpatient urogynecologic procedures at a tertiary referral center from September 2018 to June 2021. Participants recorded their postvoid residual volume (PVR), voided volume, and subjective force of stream (sFOS) for all postoperative voids until meeting criteria to stop. The primary outcome was the sensitivity of TOV parameters in predicting postoperative urinary retention, defined as PVR ≥1/2 voided volume on the first 2 postoperative voids. Sample size was set at 183 to detect a 20% difference (α = 0.05, β = 0.2, up to 20% with missing data) in sensitivity between TOV parameters. Diagnostic accuracies were compared with McNemar’s test for paired proportions, with Youden’s index calculated to determine optimal thresholds.

Results: The 160 participants had a mean age of 52.1 ± 11.4 years and a mean body mass index of 28.9 ± 5.8 kg/m2 (calculated as weight in kilograms divided by height in meters squared).Mean preoperative PVR was 25.8 ± 29.9 mL. Most participants had surgery that included a midurethral sling (137/160, 85.6%). Thirty-four (34/160, 21.3%) participants met criteria for postoperative urinary retention. The optimal recovery room TOV thresholds to predict postoperative urinary retention were PVR ≥87 mL (sensitivity 96.8%, specificity 60.0%), voided volume ≤ 150 mL (sensitivity 83.9%, specificity 72.3%), and sFOS ≤60% (sensitivity 100%, specificity 50.8%). Voided volume ≤ 150 mL had greater diagnostic accuracy than PVR ≥100 mL (156.2 vs 151.8).

Conclusions: In this cohort, PVR ≥87 mL, voided volume ≤ 150 mL, and sFOS ≤60% had optimal diagnostic accuracy for postoperative urinary retention.

Julia K. Shinnick, MD,* Christina A. Raker, ScD,† Elizabeth J. Geller, MD,‡ Charles R. Rardin, MD,* and Anne C. Cooper, MD, MA§

*Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; †Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; ‡Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Division of Urogynecology, Department of Obstetrics & Gynecology, Dartmouth Geisel School of Medicine, Dartmouth, NH.

Source: Shinnick, et al. Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters. Urogynecology 2024;00:00–00 DOI: 10.1097/SPV.0000000000001539.

Is Urine Production Rate at Night Uniform or Phasic in Patients Treated for Clinically Significant Nocturia?

A recent study from the European Urology Focus journal, “Differential Nocturnal Diuresis Rates Among Patients With and Without Nocturnal Polyuria Syndrome” the Veterans Affairs Health System analyzed frequency-volume charts of adult males with two or more nocturnal voids. After excluding patients with diuretic use, obstructive sleep apnea, chronic kidney disease, diabetes insipidus or edema, 130 subjects were included.  

From the Desk of the Editor: "Advancing Medical Treatment for LUTS while Improving Patients Quality of Life"

We are in the middle of a very exciting time treating Lower Urinary Tract Symptoms (LUTS).  The primary reason for this excitement is the new medical treatments that are available and on the horizon.  With most pharmacologic therapies, there are going to be "responders",  and some patients that fall short of the desired efficacy.  Some patients will tolerate therapies

From the Desk of the Editor - "The Impact our Therapies Have on Sleep"

Very often when a man is diagnosed with prostate cancer we consider how our therapies effect different aspects of their health and quality of life. However holistic we have become one area that we have not been as considerate about is the impact our therapies have on sleep and the subsequent impact sleep disturbance.

Thanks to Gonzalez et al. we now have data that suggest we need to look at this impact. Recently published in cancer the study compares objective and subjective sleep disturbance in patients with prostate cancer receiving androgen deprivation therapy (ADT) compared with patients with prostate cancer previously treated with surgery only as well as men without a cancer history. 

From the Desk of the Editor

For a longtime we have the impression that getting up to void at night a normal part of aging. Even when more severe, and our patients bring the impact to our attention, we largely ignore the subject. In some cases, a few general recommendations (e.g. drink less fluid before bed) may be made, perhaps a medication to treat another condition (e.g. OAB, BPH) is prescribed, and the patient is left without relief.

I think of Nocturia as the “forgotten lower urinary tract condition”. Our understanding of sleep has recently come a long way, we are only now starting to understand the homeostatic effects of sleep. We now realize the impact of sleep quality on many domains of health and well-being. It is therefore more important than ever to address conditions that are have a negative impact on sleep and sleep quality. We need to realize that Nocturia is no longer just a symptom, but rather a condition with profound impact, regardless of age.