Bibliographic Source(s)

• Finnish Medical Society Duodecim. Determining the volume of residual urine by ultrasonography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2008 Jul 23 [Various].

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Finnish Medical Society Duodecim. Determining the volume of residual urine by ultrasonography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2004 Oct 3 [Various].

Guideline Category

Diagnosis
Evaluation

Intended Users

Health Care Providers
Physicians

Guideline Objective(s)

Evidence-Based Medicine Guidelines collect summarize and update the core clinical knowledge essential in general practice. The guidelines also describe the scientific evidence underlying the given treatment recommendations.

Target Population

• Individuals with urinary incontinence
• Elderly men with urinary symptoms
• Men with urinary tract infections
• Individuals with a palpable mass in the lower abdomen
• Individuals with increased serum creatinine

Interventions and Practices Considered

Determination of the volume of residual urine by ultrasonography of the urinary bladder

Major Outcomes Considered

Inter-observer reliability and validity of ultrasonic estimation of bladder volume

Methods Used to Collect/Select Evidence

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Description of Methods used to Collect/Select the Evidence

The evidence reviewed was collected from the Cochrane database of systematic reviews and the database of abstracts of reviews of effectiveness (DARE). In addition the Cochrane Library and medical journals were searched specifically for original publications.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Classification of the Quality of Evidence

GRADE (Grading of Recommendations Assessment Development and Evaluation) Working Group 2007 (modified by the EBM Guidelines Editorial Team).

Methods Used to Analyze the Evidence

Systematic Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

Peer Review

Description of Method of Guideline Validation

Not stated

Major Recommendations

The levels of evidence [A-D] supporting the recommendations are defined at the end of the "Major Recommendations" field.

Principles

• Any doctor can determine the volume of residual urine after brief education (See Video 1 in the original guideline document).

Indications

• Urinary incontinence (to rule out overflow)
• Urinary symptoms in elderly men
• Urinary tract infection in the male
• A palpable mass in the lower abdomen
• Increased serum creatinine (to rule out obstruction)

Techniques

• The patient voids.
• Keep the ultrasonography probe in a transverse position and find a view which shows the bladder at maximum size. Freeze the view and measure the horizontal (a) and vertical (b) dimensions of the bladder.
• Move the probe to a longitudinal position find the maximum longitudinal dimension (c) of the bladder and measure it.
• The (minimum estimate of) residual urine volume = 0.6 x a x b x c (Nwosu et al. 1998) [B]. If the dimensions are given in cm the result is in mL. (See Pictures 1 and 2 in the original guideline document).
  • A volume exceeding 100 mL is abnormal and a volume exceeding 200 mL is usually an indication of treatment.
• The volume of the prostate can be measured by using the same formula (See Pictures 3 and 4 in the original guideline document).

Examining the Full Bladder

• If you intend to determine the position and depth of the bladder before bladder puncture or percutaneous cystostomy do not ask the patient to void but perform ultrasonography with a full bladder.

Definitions:

Classification of the Quality of Evidence

GRADE (Grading of Recommendations Assessment Development and Evaluation) Working Group 2007 (modified by the EBM Guidelines Editorial Team).

Clinical Algorithm(s)

None provided

References Supporting the Recommendations

• Nwosu CR Khan KS Chien PF Honest MR. Is real-time ultrasonic bladder volume estimation reliable and valid? A systematic overview. Scand J Urol Nephrol 1998 Sep;32(5):325-30. PubMed

Type of Evidence supporting the Recommendations

Concise summaries of scientific evidence attached to the individual guidelines are the unique feature of the Evidence-Based Medicine Guidelines. The evidence summaries allow the clinician to judge how well-founded the treatment recommendations are. The type of supporting evidence is identified and graded for select recommendations (see the "Major Recommendations" field).

Potential Benefits

Appropriate determination of the volume of residual urine by ultrasonography

Potential Harms

Not stated

Qualifying Statements

• Estimation of bladder volume by ultrasonography is both reliable and valid for clinical purposes but the most appropriate formula for calculation cannot be determined on the basis of systematic review.
• The poor quality of the study designs and the potential elements of bias make it impossible to recommend the most valid formula for estimating bladder volume. The variation in bladder shape at different volumes would suggest that a single formula may be inappropriate at different bladder volumes.

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools

Resources

For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Bibliographic Source(s)

• Finnish Medical Society Duodecim. Determining the volume of residual urine by ultrasonography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2008 Jul 23 [Various].

Adaptation

Not applicable: The guideline was not adapted from another source.

Source(s) of Funding

Finnish Medical Society Duodecim

Guideline Committee

Editorial Team of EBM Guidelines

Composition of Group that Authored the Guideline

Primary Author: Editors

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Finnish Medical Society Duodecim. Determining the volume of residual urine by ultrasonography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2004 Oct 3 [Various].

Guideline Availability

This guideline is included in "EBM Guidelines. Evidence-Based Medicine" available from Duodecim Medical Publications Ltd PO Box 713 00101 Helsinki Finland; e-mail: info@ebm-guidelines.com; Web site: www.ebm-guidelines.com.

Availability of Companion Documents

The following is available:

• Residual urine volume (ultrasonography). Video 1.

Electronic copies available to subscribers from Finnish Medical Society Duodecim Web site.

Patient Resources

None available

NGC STATUS

This summary was completed by ECRI on August 28 2001. The information was verified by the guideline developer as of October 26 2001. This summary was updated by ECRI on February 21 2005. This summary was updated by ECRI Institute on January 6 2009.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop produce approve or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies relevant professional associations public or private organizations other government agencies health care organizations or plans and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC AHRQ and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC AHRQ or its contractor ECRI Institute and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.