Thanagumtorn Kanate
J Med Assoc Thai. 2016 Oct;99(10):1061-6.
Postoperative urinary retention occurs in 17 to 42% of Radical hysterectomy (RH) cases. The gold standard assessment of post-void residual urine volume (PVR) is bladder catheterization. The use of the 3D portable ultrasound device (VerathonBladderScan BVI 9400) to evaluate PVR is quick, safe, non-invasive, painless, and comfortable for patients as well as being easy to use.
To compare the accuracy of ultrasound bladder scanner with that of urethral catheterization in the assessment of post-void residual urine volume (PVR).
This was a prospective study. After removal of Foley’s catheter in postoperative radical hysterectomy(RH) patients, the voiding care schedule consisted of voids after six hours or earlier if the patient had the urge. Promptly after voiding, PVR was measured using the BladderScan (Scan volume). Immediately after the procedure, urethral catheterization was performed to obtain the actual PVR (Catheter volume). The process was repeated in subsequent voids, and correlations between scan volume and catheter volume were analyzed.
Seventy patients (140 measurements) were included. A high correlation was found between the scan volume and the catheter volume (r = 0.89, p<0.001). A 91.0% specificity and 93.1% negative predictive value(NPV) were obtained using the scan volume in predicting a catheter volume of <100 ml. The difference in measurements between the two methods was not related to age, body mass index, parity, co-existing illness, type of surgical incision or duration of indwelling catheter. When catheter volume >100 ml was the cutoff for determining the need for re-catheterization, the scan volume returned 90.0% accuracy. Repetition of ultrasound scan in patients who had a first scan volume of <100 ml yielded a 97.2% specificity and 100% NPV in predicting catheter volume of <100 ml.
The Bladder Scan provides good correlation together with high rates of specificity and NPV, and it could be an alternative modality to catheterization for the measurement of PVR in postoperative RH patients.
根治性子宫切除术（RH）病例中，术后尿潴留发生率为17%至42%。评估排尿后残余尿量（PVR）的金标准是膀胱插管。使用三维便携式超声设备（Verathon膀胱扫描仪BVI 9400）评估PVR快速、安全、无创、无痛，患者感觉舒适，且易于操作。
比较超声膀胱扫描仪与尿道插管在评估排尿后残余尿量（PVR）方面的准确性。
这是一项前瞻性研究。根治性子宫切除术后患者拔除Foley导管后，排尿护理计划为术后6小时排尿，若患者有尿意可提前排尿。排尿后立即使用膀胱扫描仪（扫描量）测量PVR。操作完成后立即进行尿道插管以获取实际PVR（导管量）。后续排尿时重复该过程，并分析扫描量与导管量之间的相关性。
纳入70例患者（140次测量）。发现扫描量与导管量之间存在高度相关性（r = 0.89，p<0.001）。使用扫描量预测导管量<100 ml时，特异性为91.0%，阴性预测值（NPV）为93.1%。两种方法测量结果的差异与年龄、体重指数、产次、并存疾病、手术切口类型或留置导管时间无关。当以导管量>100 ml作为决定是否需要再次插管的临界值时，扫描量的准确率为90.0%。首次扫描量<100 ml的患者重复进行超声扫描，在预测导管量<100 ml时，特异性为97.2%，NPV为100%。
膀胱扫描仪具有良好的相关性，特异性和NPV较高，可作为术后RH患者测量PVR的替代方法，替代尿道插管。
