Normative noninvasive bladder function measurements in healthy women: A systematic review and meta-analysis

Jean F. Wyman, Jincheng Zhou, D. Yvette LaCoursiere, Alayne D. Markland, Elizabeth R. Mueller, Laura Simon, Ann Stapleton, Carolyn R.T. Stoll, Haitao Chu, Siobhan Sutcliffe

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Aim: To conduct an evidence synthesis of normative reference values for bladder function parameters in women. Methods: We conducted a systematic review and meta-analysis of studies reporting bladder function parameters obtained from noninvasive tests in healthy women. Seven databases were searched for relevant studies from inception through December 2018, with manual searching of reference lists. We included English language articles that provided quantitative data on urination frequency, voided and postvoid residual volumes, and uroflowmetry results in women without lower urinary tract symptoms. Study selection, data extraction, and quality assessment were undertaken by at least two independent reviewers. Random-effects meta-analytic models were used to derive study-level pooled mean estimates and 95% confidence intervals. Results: A total of 24 studies (N = 3090 women, age range, 18-91 years) met eligibility criteria. Pooled mean estimates of bladder function parameters were: 6.6 daytime voids (95% confidence interval (95% CI), 6.2, 7.0), 0.4 nighttime voids (95% CI, 0.0, 0.8), 1577 mL for 24-hour voided volume (95% CI 1428,1725); 12 mL for postvoid residual volume (95% CI, 4, 20); and 28 mL/sec for maximum flow rate (95% CI, 27,30). Between-study heterogeneity was high for all outcomes (I2 = 61.1-99.6%), but insufficient data were available to explore reasons for this high heterogeneity (eg, differences by age). Conclusion: Although summary mean estimates of bladder function parameters were calculated, the wide heterogeneity across studies precludes generalization of these estimates to all healthy women. Further research is needed to determine normative reference values within specific groups, such as those defined by age.

Original languageEnglish (US)
Pages (from-to)507-522
Number of pages16
JournalNeurourology and Urodynamics
Issue number2
StatePublished - Feb 1 2020

Bibliographical note

Funding Information:
We appreciate the contributions of Melissa Milbrandt who assisted in the data extraction. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium Centers and Investigators: Loyola University Chicago Multi-Principal Investigators: Linda Brubaker, MD, MS; Elizabeth R. Mueller, MD, MSME; Colleen M. Fitzgerald, MD, MS. Investigators: Cecilia T. Hardacker, MSN, RN, CNL; Jennifer M. Hebert-Beirne, PhD, MPH; Missy Lavender, MBA; David A. Shoham, PhD. University of Alabama at Birmingham Principal Investigator: Kathryn L. Burgio, PhD. Investigators: Cora E. Lewis, MD; Alayne D. Markland, DO, MSc; Gerald McGwin, PhD; Beverly R. Williams, PhD. University of California San Diego Principal Investigator: Emily S. Lukacz, MD. Investigators: Sheila Gahagan, MD, MPH; D. Yvette LaCoursiere, MD, MPH; Jesse Nodora, DrPH. University of Michigan | Ann Arbor MI Principal Investigator: Janis M. Miller, PhD, MSN. Investigators: Lawrence Chin-I An, MD; Lisa Kane Low, PhD. University of Minnesota | Minneapolis MN Multi-Principal Investigators: Bernard L. Harlow, PhD, Multi-PI; Kyle D. Rudser, PhD. Investigators: Sonya S. Brady, PhD; John Connett, PhD; Melissa L. Constantine, PhD, MPAff; Haitao Chu, MD, PhD; Cynthia S. Fok, MD, MPH; Todd Rockwood, PhD. University of Pennsylvania | Philadelphia PA Principal Investigator: Diane K. Newman, DNP, ANP-BC, FAAN. Investigators: Amanda Berry, MSN, CRNP; C. Neill Epperson, MD; Kathryn H. Schmitz, PhD, MPH, FACSM, FTOS; Ariana L. Smith, MD; Ann E. Stapleton, MD; Jean Wyman, PhD, RN, FAAN. Washington University in St. Louis | St. Louis MO Principal Investigator: Siobhan Sutcliffe, PhD, ScM, MHS. Investigators: Colleen McNicholas, DO, MSc; Aimee S. James, PhD, MPH; Jerry L. Lowder, MD, MSc; Mary Townsend, ScD. Yale University | New Haven CT Principal Investigator: Leslie Rickey, MD. Investigators: Deepa Camenga, MD, MHS; Toby Chai, MD; Jessica B. Lewis, LMFT, MPhil. Steering Committee Chair: Mary H. Palmer, PhD, University of North Carolina NIH Program Office: National Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urologic, and Hematologic Diseases, Bethesda, MD. NIH Project Scientist: Tamara Bavendam MD, MS; Project Officer: Ziya Kirkali, MD; Scientific Advisors: Chris Mullins, PhD and Jenna Norton, MPH.

Funding Information:
The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is supported by the National Institutes of Health (NIH) through cooperative agreements (grants U01DK106786, U01DK106853, U01DK106858, U01DK106898, U01DK106893, U01DK106827, U01DK106908, and U01DK106892). Additional funding from the National Institute on Aging, NIH Office on Research in Women's Health, and Office of Behavioral and Social Science. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 Wiley Periodicals, Inc.


  • Reference values
  • urinary frequency
  • urinary volume
  • uroflowmetry
  • voiding


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