Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction.

INTRODUCTION AND HYPOTHESIS: The prevalence and clinical associations of recurrent (two or more symptomatic and medically documented in the previous 12 months) urinary tract infections (UTIs) have not been subjected to comprehensive analysis in a large group of women with symptoms of pelvic floor dysfunction. METHODS: A prospective study was conducted involving 1,140 women presenting for their initial urogynecological assessment. RESULTS: The overall prevalence of recurrent UTI was 19%. Significant positive associations of recurrent UTI were: (1) nulliparity with a 3.7 x (up to 50 years) increase over the prevalence for parous women and 1.8 x (over 50 years); and (2) women with an immediate postvoid residual (PVR) over 30 ml, which is significant in women over 50 years. CONCLUSIONS: The early age decline (18-45 years) in the prevalence of recurrent UTI might be related to increasing parity. The later increase (over 55 years) was probably due to the increasing PVR effect superimposed on the nulliparity effect.

Does the presenting bladder volume at urodynamics have any diagnostic relevance?

The aim of this study is to assess the diagnostic relevance of the presenting bladder volume (PBV) at urodynamics in women. Its measurement is most accurately made by adding the voided volume at uroflowmetry and the postvoid residual. The study involved 1,140 women presenting for their initial urogynecological assessment. Multivariate analysis of the relationships between high or low PBVs and different clinical and urodynamic variables. Median PBV was 174 mL. In overall terms, women with lower PBVs (0-174 mL) are significantly more likely to be older, of lower parity (0-1), have the symptom of nocturia, and the final diagnoses of sensory urgency and detrusor overactivity. These women are significantly less likely to have posterior vaginal and apical vaginal prolapse. Women with higher PBVs (over 174 mL) are significantly less likely to have either bladder storage diagnoses. The relatively low median PBV might reduce the demonstration of clinical stress leakage and restrict the interpretation of uroflowmetry data.

Immediate postvoid residual volumes in women with symptoms of pelvic floor dysfunction.

OBJECTIVE: To estimate the prevalence and clinical and urodynamic associations of postvoid residual volumes (PVRs), measured immediately after micturition, in women with symptoms of pelvic floor dysfunction. METHODS: The patients were 1,140 women presenting consecutively for their initial urogynecological assessment, including urodynamics. They were studied prospectively. Measurement of PVRs was by transvaginal ultrasonography within 60 seconds of micturition. After the estimation of prevalence of the different levels of PVR, an appropriate upper limit of normal PVR was estimated and associations then were sought for PVRs with a wide range of clinical and urodynamic parameters. RESULTS: The overall prevalence of PVRs was 76% at 0-10 mL, 5% at 11-30 mL, 5% at 31-50 mL, 8% at 51-100 mL, and 6% at more than 100 mL. Thus, using transvaginal ultrasonography, 81% of immediate PVRs were 30 mL or less. Higher than 30 mL, a significantly increased prevalence of women presenting with recurrent urinary tract infections (UTIs) was noted (P<.001). The level of 30 mL was deemed to be an appropriate upper limit of normal PVR. The prevalence of PVRs higher than 30 mL increased significantly with age (P<.001) and higher grades of prolapse (P<.001). There was a significant inverse relation of PVRs higher than 30 mL to the symptom of stress incontinence (P=.018) and the diagnosis of urodynamic stress incontinence (P<.001). CONCLUSION: Eighty-one percent of immediate PVRs (95% confidence interval 79-84%) in symptomatic women are 30 mL or less. Postvoid residual volumes higher than this level are significantly associated with increasing age, higher grades of prolapse, and an increased prevalence of recurrent UTIs. LEVEL OF EVIDENCE: II.