Effects of Voiding in Standing and Sitting Positions on Uroflowmetric Parameters and Post-Void Residual Urine in Boys

Nilufer Özgürbüz; Ismet Eser


Urol Nurs. 2018;38(2):67-72. 

In This Article

Abstract and Introduction


Forty percent of children are referred to outpatient clinics because of lower urinary tract disorders, and complete emptying of the bladder is important in preventing urinary tract infections and stone formation. Thirty-two boys in this study voided in sitting and standing positions, and uroflowmetric and ultrasound measurements of their PVR urine were compared between the two groups. Except for EMG activity, voiding position seems not to affect uroflowmetric parameters and PVR urine. Outcomes of this study suggest both voiding positions can be used as an alternative voiding position of each other.


Forty percent of children are referred to outpatient clinics because of lower urinary tract (LUT) disorders (such as overactive/underactive bladder, dysfunctional voiding, enuresis) (Nevéus et al., 2006), and LUT disorder symptoms were detected in 161 (21.8%) school-aged children (Vaz et al., 2012). More than one clinical technique is used in the diagnosis, follow up, and treatment approaches to these voiding conditions, but uroflowmetry is one of the most used methods due to its availability in the outpatient clinic and its noninvasive nature. Besides this, a major functional service of uroflowmetry is the possibility to predict the outcomes of a planned invasive intervention (Abrams, Farrar, Turner-Warwick, Whitesite, & Feneley, 1979; Andersen, Nordling, & Walter, 1979; Cal et al., 2000). Despite being influenced by a number of factors, if used together with post-void residual (PVR) urine, uroflowmetry is a quick and economic test for the evaluation of children with LUT concerns.

Complete emptying of the bladder is important in preventing urinary tract infections (UTIs) and stone formation (Eryıldırım, Tarhan, Kuyumcuo lu, Erbay, & Pembegül, 2006). PVR urine and high-voiding pressure may facilitate pathologies, such as dysfunctional voiding (DV) and vesicoureteral reflux (VUR) (De Paepe et al., 1998; Jerkins, Noe, Vaughn, & Roberts, 1987; Pfister et al., 1999). Urotherapy is an important treatment option in pathologies, such as UTI, DV, and VUR. Determining uroflowmetric parameters and measuring PVR are important tools of urotherapy in evaluation of the patient's condition.

In a uroflowmetric examination, measurements of maximum flow rate (Qmax), voiding time (VT), voided volume (VV), PVR, flow curve (FC), and pelvic floor activities (using electromyography [EMG]) can be performed (see Figure 1). However, using inappropriate techniques or conducting measurements of this simple method under less than ideal circumstances may lead to erroneous results. Uroflowmetric outcomes can be affected by age, sex, voided volume, patient's psychological condition, history of recent or frequent urethral catheterization, and voiding position (Devreese et al., 2000; Drach, Ignatoff, & Layton, 1979; Drach, Layton, & Binard, 1979; Eryıldırım et al., 2006; Moore, Richmond, Sutherst, Imrie, & Hutton, 1991; Riehmann et al., 1998; Tessier & Schick, 1990; Unsal & Cimentepe, 2004a, b; Yamanishi et al., 1998).

Figure 1.

Definitions Used in the Discussion

For these reasons, providing accurate uroflowmetric measurements is important in determining the correct voiding position, teaching the correct voiding behavior, eliminating possible factors negatively affecting voiding, and taking into account all other factors influencing voiding. However, studies conducted on adults evaluating effects of different voiding positions on uroflowmetric parameters revealed different results, and there are only a limited number of published studies conducted on children (Aghamir, Mohseni, & Arasteh, 2005; Amjadi, Hajebrahimi, & Soleimanzadeh, 2011; El-Bahnasawy & Fadl, 2008; Eryıldırım et al., 2006; Kamal, Agarwal, Mandal, Mavuduru, & Kshetrapal, 2016; Khan, & Zaidi, 2017; Tavakkoli-Tabassi, Taghavi, Firouz, & Mohammadi, 2015; Unsal et al., 2004b; Yazıcı, Turker, & Dogan, 2014).

The purpose of this study was to investigate effects of voiding in standing and sitting positions in boys on uroflowmetric parameters and PVR urine.