With the patient in supine position, a 2- to 5-MHz curvilinear probe is placed above the patient’s symphysis pubis in the midline position. Introduction, Scanning Technique and Anatomy, and Billing
#CPT CODE FOR POST VOID RESIDUAL BLADDER SCAN TRIAL#
The foley was then removed and the patient passed a trial of void in the ED and was discharged with a recommendation to hold Coumadin x 24 hrs. Hgb and Hct levels were noted to be normal. On lab evaluation, the INR was found to be slightly supratherapeutic. A three-way Foley catheter was inserted and the bladder was irrigated to pink-colored urine. Ultrasound images of the bladder revealed a large clot, likely spontaneous, that was causing the patient’s hematuria and contributing to obstruction of the bladder outlet. A POCUS image of the bladder revealed the following:įigure 5. When the new catheter was placed and the balloon inflated, the patient reported significant pain. On examination, his catheter was found to be obstructed with urinary sediment and clot and was removed with a plan for exchange. He stated that his catheter was changed every 8 weeks and had just been changed the prior month. Imaging eventually showed severe compression of the spinal nerve roots by discs at the L2-3 and 3-4 levels, necessitating emergent decompression.Ī 59-year-old male with a longstanding history of BPH and urinary retention presented with a chief complaint of suprapubic abdominal pain and non-draining of his foley catheter. 1 In this case, the patient was just on the cusp of normal vs abnormal post-void urinary volume, but with his other clinical signs and symptoms, warranted emergency spine consultation and MRI. Two hundred milliliters or greater is generally regarded as the threshold for retention. Current literature defines normal post-void bladder volume in adults as < 50 mL in patients under 65 years of age, and < 100 mL in those older than 65. Calculation of bladder volume using the ellipsoid method (L x W x H x 0.52 = mL)įindings concerning for Cauda Equina were all present in this patient’s history, physical exam, and workup. After use of a urinal, bedside POCUS was used to measure his post-void residual bladder volume:įigure 3. He reports that he is able to urinate but unable to state if his urinary frequency has increased beyond “my normal prostate issues.” He notes he has fallen twice because “my legs just seem to give out on me.” On physical exam, he demonstrates 4+/5 bilateral LE strength, mild distal sensory loss, and absent patellar and Achilles reflexes. He denied fever, abdominal pain, and dysuria. Soucy, DO, FACEP, Co-Chair, System Wide Clinical Ultrasound Subcommittee, Assistant Professor, Emergency Medicine Director, Emergency Ultrasound Director, Emergency Ultrasound Fellowship, Co-Chair, System Wide POCUS, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, DartmouthĪ 65-year-old male with a history of HTN, BPH, IDDM, and lumbar spinal stenosis presented to the ED with low back pain and lower extremity weakness. Woods, MD, FACEP, Co-Chair, System Wide Clinical Ultrasound Subcommittee, Emergency Physician, INOVA Fairfax Hospital, Clinical Assistant Professor, George Washington University
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