Authors' objectives:

This health technology and policy assessment (HTPA) will focus specifically on portable bladder ultrasound in the management of urinary conditions.

Authors' results and conclusions: Studies examining the clinical utility of portable bladder ultrasound in the elderly population all found the device acceptable, including one study which reported that the device underestimated catheterized bladder volume. Amongst 3 studies of portable bladder ultrasound devices in urology patients, 2 of the 3 found the devices acceptable to use, although Huang et al did not find the devices as accurate for small post-void residual (PVR), and Goode et al found that they overestimated catheterized bladder volume. In the remaining study by Alnaif and Drutz, the authors reported that because of misaimed scanheads there were missed bladders, and that partial bladder volume measurements where lateral borders were missing resulted in the underestimation of PVR measurements. They concluded that caution should be used in interpreting PVR from Portable bladder ultrasound machines, and that catheterization may be the preferred assessment modality if an accurate PVR measurement is necessary. Three studies in post-operative populations all found Portable bladder ultrasound reasonably acceptable, with 2 studies finding that the devices overestimated catheter derived bladder volumes by 7% and 21 ml, with the other study finding the opposite, that the devices overestimated catheter bladder volume by 39 ml. Two studies in rehabilitation settings found Portable bladder ultrasound to underestimate catheter derived bladder volumes, yet both authors concluded that the mean errors were within acceptable limits. Two studies in the neurogenic bladder population also found Portable bladder ultrasound to be an acceptable alternative to catheterization despite the fact that it was not as accurate as catheterization for obtaining bladder volumes. Lastly, in studies that examined negative health outcomes avoided, unnecessary catheterizations were decreased by 20 to 47% and urinary tract infections (UTIs) were decreased by 38 to 50% after the implementation of Portable bladder ultrasound. In sum, all but one article advocated the use of Portable bladder ultrasound as an alternative to catheterization.

Authors' recommendations: Policy Options Option 1: Recommend portable bladder ultrasound for use in complex continuing care and rehabilitation facilities for neurogenic bladder populations and in urology settings for urinary incontinence (UI) assessment. Option 2: Recommend portable bladder ultrasound for acute post-surgical care settings. Data is not available for catheterized populations in hospital care settings and as such expected outcomes cannot be estimated reliably; however hospitals should feel free to explore and evaluate the clinical utility of Portable bladder ultrasound use based on their populations needs. Option 3: Do not recommend portable bladder ultrasound for the catheterized population in long-term care (LTC). Only 2.8% of all LTC residents are catheterized, and at the institution level, the purchase of this device would not be justified for so few patients (approximately 3 catheterized patients per facility). Option 4: Recommend portable bladder ultrasound for LTC for the purpose of prompted voiding. Option 5: Recommend use of portable bladder ultrasound in community and home care settings. It is difficult to comment on this option given the lack of literature on, portable bladder ultrasound use in home care and community care settings, and population catheterization rates and incontinence data; as outcomes dependant on case mix served, Portable bladder ultrasound should be used at own discretion.

Authors' methods: Review

Project Status: Completed

Year Published: 2006

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_pbu_040106.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_pbu_040106.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care