Postvoid residual volume cannot be accurately estimated by bimanual examination

This study aimed to test the recommendation in the Agency for Health Care Policy and Research Practice Guideline on urinary incontinence that postvoid residual volume PVR estimates can be done by palpation. Postvoid residual volumes were obtained on 50 consecutive women presenting for evaluation of incontinence. Volumes were first estimated by bimanual examination and were then immediately measured by catheterization. Of 7 women who had a positive PVR, defined as greater than 50 ml, only 1 was estimated at greater than 50 ml on bimanual examination. The sensitivity of bimanual examination compared to catheterization to detect a positive PVR was 14%; specificity was 67%. Based on this assessment, the AHCPR guideline's inclusion of palpation estimates of PVR cannot be endorsed, unless a given practitioner has repeated a similar type of evaluation in his or her practice to determine whether the sensitivity is higher than that found in this study.