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

doi:10.1002/nau.24265

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 journal › Review article › peer-review

14 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	507-522
Number of pages	16
Journal	Neurourology and Urodynamics
Volume	39
Issue number	2
DOIs	https://doi.org/10.1002/nau.24265
State	Published - 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.

Keywords

Reference values
urinary frequency
urinary volume
uroflowmetry
voiding

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10.1002/nau.24265

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

abstract = "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.",

keywords = "Reference values, urinary frequency, urinary volume, uroflowmetry, voiding",

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

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: {\textcopyright} 2020 Wiley Periodicals, Inc.",

year = "2020",

month = feb,

day = "1",

doi = "10.1002/nau.24265",

language = "English (US)",

volume = "39",

pages = "507--522",

journal = "Neurourology and Urodynamics",

issn = "0733-2467",

publisher = "Wiley-Liss Inc.",

number = "2",

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TY - JOUR

T1 - Normative noninvasive bladder function measurements in healthy women

T2 - A systematic review and meta-analysis

AU - Wyman, Jean F.

AU - Zhou, Jincheng

AU - Yvette LaCoursiere, D.

AU - Markland, Alayne D.

AU - Mueller, Elizabeth R.

AU - Simon, Laura

AU - Stapleton, Ann

AU - Stoll, Carolyn R.T.

AU - Chu, Haitao

AU - Sutcliffe, Siobhan

N1 - 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.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

KW - Reference values

KW - urinary frequency

KW - urinary volume

KW - uroflowmetry

KW - voiding

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DO - 10.1002/nau.24265

M3 - Review article

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JF - Neurourology and Urodynamics

IS - 2

ER -

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

Abstract

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