Sensation of incomplete bladder emptying

Specialty: Nephrology and urology.

• subjective bladder residue
• post-micturition urinary urgency

Why it occurs

• Benign prostatic hyperplasia (causes obstruction and actual retention of urine in the bladder after urination)
• Overactive bladder (sensory hypersensitivity of the detrusor that generates the false perception of continuous bladder filling)
• Cystocele (prolapse of the bladder into the vagina, which generates urethral kinking and makes complete emptying of the prolapsed portion difficult)
• Bladder neck stenosis (due to scarring after previous urological surgery)
• Atonic neurogenic bladder (lack of detrusor contractility that causes a permanently high residual volume)

Initial workup

Pre- and post-void bladder or vesicoprostatic ultrasound to objectively quantify the residual urine volume (a post-void residual >100 ml is considered pathological); pressure-flow study (urodynamics) to distinguish between outflow tract obstruction and detrusor weakness; Cystoscopy to rule out bladder neck stenosis.

Standard management

• Tamsulosin — 0.4 mg orally daily to reduce urethral resistance
• Mirabegron — 50 mg orally daily to calm bladder sensory instability, provided that the measured postvoid residual is less than 100 ml to avoid inducing acute urinary retention
• Clean intermittent bladder catheterization (scheduled manual emptying technique using a catheter if the postvoid residual is persistently high, >200 ml, and is not amenable to surgical correction).