title: Diagnosis of Postoperative Urinary Retention Using a Simplified Ultrasound Bladder Measurement.
abstract: BACKGROUND
  In this study, we sought to determine whether a simplified ultrasound measurement of the largest transverse diameter, using a standard ultrasound machine, could be used to diagnose postoperative urinary retention (POUR). This method may replace expensive bladder volume measuring devices or a more complex ultrasound procedure (involving the measurement of 3 bladder diameters).
  
  
  METHODS
  Patients at risk of POUR if unable to void after orthopedic surgery were evaluated in the postanesthesia care unit before discharge. Bladder diameter was first measured using a portable ultrasound device (Vscan®; GE Healthcare, Wauwatosa, WI). An automated evaluation of bladder volume was then performed (Bladderscan® BVI 3000; Diagnostic Ultrasound, Redmond, WA). Finally, when a bladder catheterization was performed, the actual urinary volume was measured. The main outcome was a bladder volume ≥600 mL as measured using the automated ultrasound scanner (Bladderscan BVI 3000) or by catheterization. Correlations between bladder volumes and diameter were studied and receiver operating characteristic curves were constructed to determine the performance in predicting a bladder volume ≥600 mL. A "gray zone" approach was developed because a single cutoff value may not always be clinically significant.
  
  
  RESULTS
  One hundred patients were included and underwent a Bladderscan measurement. Urinary volume after catheterization was obtained in 49 patients. A significant correlation was found between the largest transverse diameter and urinary volumes assessed by the 2 methods (Bladderscan and catheterization). Pearson correlation coefficients were r = 0.80 (95% confidence interval [CI], 0.72-0.86; P < 0.001) and r = 0.79 (95% CI, 0.65-0.88; P < 0.001), respectively. The area under the receiver operating characteristic curves for the prediction of a bladder volume ≥600 mL were 0.94 (95% CI, 0.88-0.98) and 0.91 (95% CI, 0.79-0.97), respectively, for urinary volumes assessed by Bladderscan and catheterization. The optimal cutoff value was 9.7 cm for both methods. The gray zone was narrow, ranging from 9.7 to 10.7 cm thus limiting inconclusive measurements.
  
  
  CONCLUSIONS
  A simple ultrasound measurement of the largest transverse bladder diameter seemed to be helpful to exclude or confirm POUR.
authors: Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France; and Departments of Anesthesia and Critical Care Medicine and Biostatistics, Lapeyronie University Hospital, Montpellier, France.
authors: Aurélien
authors: A
authors: Daurat
authors: Olivier
authors: O
authors: Choquet
authors: Sophie
authors: S
authors: Bringuier
authors: Jonathan
authors: J
authors: Charbit
authors: Michael
authors: M
authors: Egan
authors: Xavier
authors: X
authors: Capdevila
mesh_terms: D000368:Aged; D019540:Area Under Curve; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014563:Urodynamics
references: Tammela T, Kontturi M, Lukkarinen O. Postoperative urinary retention. II. Micturition problems after the first catheterization. Scand J Urol Nephrol. 1986;20:257–60
references: Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–57
references: Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87:816–26
references: Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg. 2005;101:592–6
references: Griesdale DE, Neufeld J, Dhillon D, Joo J, Sandhu S, Swinton F, Choi PT. Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth. 2011;58:1097–104
references: Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg. 1999;89:90–7
references: Hwang JY, Byun SS, Oh SJ, Kim HC. Novel algorithm for improving accuracy of ultrasound measurement of residual urine volume according to bladder shape. Urology. 2004;64:887–91
references: Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with an ultrasound scanner. Acta Anaesthesiol Scand. 2002;46:279–82
references: Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40
references: Balderi T, Mistraletti G, D’Angelo E, Carli F. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol. 2011;77:1050–7
references: Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5
references: Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, Tavernier B. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115:231–41
references: McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996;1:30
references: Dudley NJ, Kirkland M, Lovett J, Watson AR. Clinical agreement between automated and calculated ultrasound measurements of bladder volume. Br J Radiol. 2003;76:832–4
references: Frederiksen CA, Juhl-Olsen P, Larsen UT, Nielsen DG, Eika B, Sloth E. New pocket echocardiography device is interchangeable with high-end portable system when performed by experienced examiners. Acta Anaesthesiol Scand. 2010;54:1217–23
references: Dijos M, Pucheux Y, Lafitte M, Réant P, Prevot A, Mignot A, Barandon L, Roques X, Roudaut R, Pilois X, Lafitte S. Fast track echo of abdominal aortic aneurysm using a real pocket-ultrasound device at bedside. Echocardiography. 2012;29:285–90
references: Rosseland LA, Bentsen G, Hopp E, Refsum S, Breivik H. Monitoring urinary bladder volume and detecting post-operative urinary retention in children with an ultrasound scanner. Acta Anaesthesiol Scand. 2005;49:1456–9
references: Moselhi M, Morgan M. Use of a portable bladder scanner to reduce the incidence of bladder catheterisation prior to laparoscopy. BJOG. 2001;108:423–4
references: Stéphan F, Sax H, Wachsmuth M, Hoffmeyer P, Clergue F, Pittet D. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis. 2006;42:1544–51