Urinary retention, namely a high post-void residual volume (PVR) caused by voiding dysfunction, is one of the most prevalent urogynecological conditions. The etiology is various, as drug treatment, neurological disorders, surgery or urinary tract infections may be responsible for the disturbance. Depending on the extent of the retained volume, immediate management is necessary to avoid further complications. 
Although in common medical practice PVR of more than 100ml is likely to be drained, there is a paucity of data answering the question what kind of pathogenicity an elevated PVR in women causes. 
Aim of the current study is to evaluate women with the clinical presentation of PVR, the acceptability and effect of current drainage solutions and – consecutively – the effect of drainage on clinical symptoms.

This is a single-center prospective study. Data were collected from women with PVR>100ml immediately after micturition between January 2020 and December 2022. We involved all women who consulted our tertiary referral clinic with various urogynaecological symptoms. Demographic data, menopause status and hormon replacement therapy status were assessed.
Visual analogue scale (VAS) from 0 to 10 was performed asking the patients about the bother of symptoms. Methods of drainages (intermittent self catheterization, indwelling catheter, suprapubic catheter) and development of symptoms and VAS was determined before therapy and six months after.

A total of 239 patients, aged 23 to 92 years were recruited, with a mean age of 61.2 years. Residual urine level ranged from 170ml to 2310ml. The study revealed that 57% of the patients had urinary tract infection (UTI) as their main symptom. Fifteen percent suffered from overactive bladder (OAB) and only 4% demonstrated stress urinary incontinence (SUI). Mixed urinary incontinence was found in 23% of women. Only 9% of patients responded to drug treatment. Intermittent self-catheterization (ISC) was used to drain PVR in 89% of patients. Eleven percent had a significant improvement, while in women over 60 years, this improvement was only 4%. VAS developed from mean of 7,2 to a mean of 1,7 showing significant improvement of symptoms during drainage.

Urinary tract infection is a main symptom in high postvoid residual. Drainage methods like clean intermittent self-catheterization were superior to drug treatment to solve high postvoid residual volume.

Significant residual urine may indeed cause recurrent urinary tract infections, OAB and stress urinary incontinence causing significant sickness in women. Intermittent clean self-catheterization and other forms of drainage may improve the symptoms and the burden of bother. However, in elderly patients residual urine overall may remain an issue not resolving after drainage.