• 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].

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

• Urinary incontinence
• Urinary symptoms
• Urinary tract infection
• A palpable mass in the lower abdomen
• Increased serum creatinine

Diagnosis
Evaluation

Family Practice
Internal Medicine

Health Care Providers
Physicians

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.

• 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

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

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

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

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.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

1. Strong research-based evidence. Multiple relevant, high-quality scientific studies with homogenic results.
2. Moderate research-based evidence. At least one relevant, high-quality study or multiple adequate studies.
3. Limited research-based evidence. At least one adequate scientific study.
4. No research-based evidence. Expert panel evaluation of other information.

Systematic Review

Not applicable

Not stated

Not applicable

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

Peer Review

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

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.

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; DARE-981930, 2000) [B]. If the dimensions are given in cm, the result is in mL.
• 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.

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:

Levels of Evidence

Levels of Evidence

1. Strong research-based evidence. Multiple relevant, high-quality scientific studies with homogenic results.
2. Moderate research-based evidence. At least one relevant, high-quality study or multiple adequate studies.
3. Limited research-based evidence. At least one adequate scientific study.
4. No research-based evidence. Expert panel evaluation of other information.

None provided

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).

Appropriate determination of the volume of residual urine by ultrasonography

Not stated

• 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.

An implementation strategy was not provided.

Getting Better

Effectiveness

• 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].

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

2000 May 9 (revised 2004 Oct 3)

Finnish Medical Society Duodecim - Professional Association

Finnish Medical Society Duodecim

Editorial Team of EBM Guidelines

The group consisted of primary care physicians and specialists.

Not stated

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

None available

None available

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