Application of Point-of-Care Ultrasound in Predicting Spontaneous Voiding in Postoperative Gynecological Patients with Urinary Urgency After General Anesthesia

Application of Point-of-Care Ultrasound in Predicting Spontaneous Voiding in Postoperative Gynecological Patients with Urinary Urgency After General Anesthesia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of Point-of-Care Ultrasound in Predicting Spontaneous Voiding in Postoperative Gynecological Patients with Urinary Urgency After General Anesthesia Jiayu Tan, Qiongfang Zhu, Jiaxin Liu, Tiantian Gan, Yubo Kang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7293057/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective To explore the application value of point-of-care ultrasound (POCUS) in evaluating postoperative gynecological patients who complain of urinary urgency during the recovery period after general anesthesia, to clarify the cause of urgency, identify the risk of urinary retention, and provide a reference for catheterization decisions. Methods A total of 50 postoperative patients who experienced urinary urgency without indwelling catheters were assessed using both physical percussion and POCUS to estimate bladder volume. The examination results and subsequent voiding outcomes were recorded. The positive rates and false-negative rates of both methods were compared, and the association between spontaneous voiding ability and bladder volume, percussion findings, and perioperative variables was analyzed. Results The positive rate of POCUS was 62.00%, significantly higher than that of physical percussion at 34.00% (P = 0.01), with a false-negative rate of 28% for percussion. Within 60 minutes postoperatively, 31 patients voided spontaneously. Based on ultrasound assessment, 19 patients had bladder volumes 600 ml. Patients who voided had a median bladder volume of 300.14 ml, significantly higher than 175.81 ml in those who did not (P = 0.030). Spontaneous voiding was significantly associated with bladder volume. Other factors such as age, BMI, duration of surgery and recovery, and intraoperative and recovery fluid volumes were not significantly associated with spontaneous voiding (P > 0.05). Conclusion Postoperative spontaneous voiding ability is closely related to bladder volume. POCUS demonstrates superior sensitivity and accuracy compared to physical percussion in identifying the risk of urinary retention. Early intervention guided by POCUS provides an objective basis for postoperative catheterization decisions. Bedside ultrasonography Gynecological surgery General anesthesia Urinary retention Prediction of spontaneous voiding Figures Figure 1 Figure 2 Figure 3 Introduction In 2011, the United States launched the “Precision Medicine” initiative, promoting a shift in medical practice toward individualized and refined care [1]. In 2020, Guangdong Province established the first “Precision Anesthesia” subcommittee, marking the deep integration of precision concepts into the field of anesthesia [2]. Precision anesthesia encompasses accurate anesthetic monitoring, drug administration, fluid management, and postoperative recovery management—most of which are carried out in the Post-Anesthesia Care Unit (PACU). This phase is crucial for ensuring patient safety and promoting rapid recovery after surgery [3]. That same year, Moore et al. introduced the concept of “Point-of-Care Ultrasonography” (POCUS) in The New England Journal of Medicine , emphasizing its significant value in perioperative care [4]. In recent years, with advancements in ultrasound visualization technology, POCUS has become an integral part of precision anesthesia. It allows for rapid intraoperative and postoperative assessments, assisting clinicians in making qualitative, localized, time-sensitive, and quantitative diagnostic decisions, thereby improving the efficiency and safety of perioperative management. Literature reports [5] indicate that POCUS is now widely used in intensive care and postoperative management, particularly for bladder function assessment. For patients with indwelling urinary catheters, POCUS can be used to measure bladder volume in real time, detect urinary retention, assess catheter patency, locate catheter position, and guide catheterization procedures and timing. This facilitates early catheter removal and helps prevent complications such as catheter-associated urinary tract infections. POCUS offers several advantages—non-invasiveness, ease of use, and intuitive results—which make it especially suitable for patients who are conscious postoperatively but experience a sense of urgency to urinate. It is of significant clinical value in identifying the cause of urinary urgency, assessing the ability to urinate spontaneously, and evaluating the risk of urinary retention [6]. This study aims to explore the application value of POCUS in predicting spontaneous voiding ability in gynecologic surgery patients who report urinary urgency during the PACU recovery period. The goal is to provide an objective basis for decisions regarding postoperative catheterization and to optimize bladder management strategies. Materials and Methods General Information From January 2022 to June 2024, a total of 50 patients who underwent general anesthesia for gynecologic surgery and recovered in the PACU were enrolled. All patients met the American Society of Anesthesiologists (ASA) Physical Status Classification I–III, reported postoperative urinary urgency, and had no indwelling urinary catheter. The patients had a mean age of 35.66 ± 8.93 years and a body mass index of 21.94 ± 3.29 kg/m². Among them, 24 received general anesthesia with tracheal intubation and 26 received intravenous anesthesia. The average surgery duration was 85.07 ± 60.2 minutes, and the average fluid input was 769.40 ± 519.95 mL. Informed consent was obtained from all participants, and the study was approved by the institutional ethics committee. Methods Study Subjects . Patients who underwent general anesthesia and were sent to the PACU with a tracheal tube had the tube removed once extubation criteria were met; patients who underwent intravenous anesthesia were directly sent to the PACU for observation. Sedation was maintained at a Richmond Agitation-Sedation Scale (RASS) score of 0 to +1. During recovery, for patients without indwelling catheters but complaining of urinary urgency, a self-controlled method was used: physical examination followed by POCUS assessment. Physical examination involved percussion over the suprapubic region to determine whether a dull sound indicated bladder distension. POCUS examinations were performed by anesthesia nurses trained in a standardized protocol. The bladder was scanned above the pubic symphysis using a moving probe to obtain the maximal transverse and longitudinal cross-sections. Three bladder diameters were measured—transverse, vertical, and anteroposterior—and bladder volume was calculated using the commonly used formula: V (mL) = transverse × anteroposterior × vertical × 0.52 [7] (see Figures 1–2). The calculated value represents bladder volume. The findings from percussion and POCUS assessments were then compared with the patient's actual urination outcome to analyze the correlation between the assessment methods, symptoms, and clinical results. Observation Indicators . The criteria for physical examination were as follows: percussion over the area superior to the pubic symphysis producing a tympanic sound was considered positive, while a dull sound was considered negative. The POCUS assessment criterion was based on bladder volume: when the bladder volume exceeded 150 mL, a sensation of urgency to urinate typically occurred [8], which is regarded as the clinical threshold for the onset of micturition desire. Outcome Measures . Bladder volumes were calculated using Formula 1 and Formula 2. For patients whose POCUS-assessed bladder volume was ≥150 mL, spontaneous voiding was encouraged. The occurrence of urination within 15 minutes post-assessment was observed. Actual urine output was recorded and compared with the estimated bladder volume from ultrasound, in order to evaluate the consistency between the two. Quality Control . After the initial POCUS examination was performed by trained nursing staff, all ultrasound findings were independently reviewed and verified by attending or senior anesthesiologists certified in POCUS, ensuring accuracy and consistency in image interpretation. Statistical Analysis . All statistical analyses were conducted using SPSS version 27.0. Descriptive statistics were applied for data summarization. Continuous variables were expressed as mean ± standard deviation (x̄ ± s), while categorical variables were presented as frequencies and percentages (n, %). The correlation between the bladder volume estimated by the two formulas and the actual voided volume was analyzed using the mean squared error (MSE) method to assess agreement and predictive validity. Result Comparison of Two Examination Results of the Patient The comparison between percussion and ultrasound results is shown in Table 1. Table 1 Comparison of Two Examination Results of the Patient (n=50, x±s) Method Total (n=50) Positive (n) Negative (n) Positive Rate (%) False Negative Rate (%) Percussion 17 33 34.00 - Ultrasound 31 19 62.00 28.00 Note: The false negative rate refers to the proportion of cases where the test result is negative but the patient actually has urinary retention. Distribution of Patient Urination Time The postoperative spontaneous urination times of patients are summarized in Table 2. Table 2. Distribution of Patient Urination Time (n = 50) Item Spontaneous Urination Inability to Urinate Spontaneously < 15 min 15-30 min 30-60 min Number of Patients (n) 15 14 2 19 Total 31 Note: Patients who are still unable to urinate spontaneously within 1 hour postoperatively require further assessment of urination function. Bladder Volume Distribution by POCUS Scan (n=50) Table 3. Bladder Volume Distribution by POCUS Scan (n=50) The distribution of bladder volumes measured by POCUS is presented in Table 3. Item 600 ml Number of Patients (n) 19 26 5 Note: Clinically, 150 mL is often considered the preliminary threshold for urination stimulus. Volumes over 600 mL suggest a significant risk of bladder overdistension. POCUS (Point-of-Care Ultrasound) refers to bedside ultrasound examination. Analysis of the Relationship Between Spontaneous Urination and Patient Data The relationship between bladder volume and spontaneous urination time is shown in Table 4. The association between bladder volume measured by ultrasound and spontaneous urination is illustrated in Fig. 3. Table 4. Analysis of the Relationship Between Spontaneous Urination and Patient Data Variable Spontaneous Urination (N1 = 11) Inability to Urinate Spontaneously (N2 = 39) Test Statistic P Value Age / Median [IQR] 33.00 [11.50] 40.00 [13.00] 265.5 0.236 BMI 22.65 ± 3.63 21.74 ± 3.21 0.75 0.464 Duration of Surgery (min) / Median (Min-Max) 80.00 (25.00–150.00) 60.00 (30.00–330.00) 238 0.588 Duration in Recovery (min) / Median (Min-Max) 60.00 (40.00–120.00) 60.00 (35.00–260.00) 242 0.519 Intraoperative Fluid Volume (mL) / Median (Min-Max) 650.00 (200.00–1700.00) 700.00 (150.00–3100.00) 208.5 0.897 PACU Fluid Volume (mL) / Median (Min-Max) 0.00 (0.00–1000.00) 0.00 (0.00–500.00) 249 0.211 Percussion Negative n (%) 5 (33.33%) 10 (66.67%) — 0.269 Positive n (%) 6 (17.14%) 29 (82.86%) Bladder Volume (mL) / Median [IQR] 300.14 ± [147.97] 175.81 ± [230.84] 307 0.03 Note: Intergroup comparisons were conducted using nonparametric testing (Mann–Whitney U test). The results suggest that bladder volume is a significant factor influencing postoperative spontaneous urination ability (P < 0.05). Discussion POCUS-Assisted Evaluation of the True Etiology Behind Subjective Urinary Urgency For minor gynecologic procedures such as hysteroscopy, cervical conization, Bartholin’s gland abscess drainage, and suction curettage, intraoperative single-catheterization is frequently performed due to surgical manipulation in the lower abdomen. Postoperatively, some patients may report urinary urgency; however, this symptom can be multifactorial. It may stem from urethral irritation due to catheterization or from true bladder distention. Nevertheless, patients often struggle to distinguish between uterine cramping and bladder fullness and may misinterpret lower abdominal discomfort as urinary urgency, resulting in diagnostic inaccuracies [9]. In this study, POCUS revealed that 38% of patients reporting urinary urgency had bladder volumes less than 150 mL—some even just a few dozen milliliters—indicating that the symptom likely originated from urethral irritation rather than actual urinary retention. This could be associated with intraoperative catheterization and localized postoperative tissue stimulation. Therefore, POCUS proves effective in differentiating between urethral irritation and true bladder filling, minimizing misdiagnosis [10]. Additionally, the study observed that physical percussion typically fails to elicit tympanic sounds when the bladder volume is below 300 mL. When volumes exceed 500 mL, percussion or palpation often causes significant discomfort. This issue is particularly pronounced in obese patients, where increased abdominal fat can attenuate percussion sounds, resulting in a higher risk of false negatives. Compared with traditional physical examination, POCUS offers a non-invasive, bedside imaging modality that enables real-time, objective, and accurate evaluation of bladder volume, thus enhancing early detection of postoperative urinary retention (POUR) [11]. Clinical Risk of POUR After Minor Gynecologic Surgery Postoperative urinary retention (POUR) is a common complication after anesthesia and surgery, with reported incidence rates ranging from 5–70% [12]. If not managed promptly, POUR can lead to bladder overdistension, detrusor dysfunction, bladder injury, and even urinary tract infections. Gynecologic procedures, being pelvic in nature, are closely associated with the risk of POUR. Previous studies have shown that the incidence of POUR after total hysterectomy ranges from 3.8–21.0% internationally, and from 7.55–44.9% in Chinese literature [13]. Laparoscopic radical hysterectomy (LRH), due to its complexity and risk of nerve injury, has a reported POUR incidence of 2.6–44.9% [13]. Normal bladder capacity ranges from 400 to 600 mL. Some studies suggest that early detection of urinary retention within 1–2 hours postoperatively—even when bladder volumes reach 500–1000 mL—does not necessarily impair long-term bladder function [14]. However, other studies recommend catheterization when bladder volumes exceed 600 mL to prevent further complications. Although there is limited systematic research on POUR after minor gynecologic procedures such as hysteroscopy or conization, our study identified associated risks. For example, two patients who underwent hysteroscopy were administered intravenous furosemide (10 mg and 20 mg, respectively) during surgery and received single catheterization upon completion. In the recovery room, both reported urinary urgency. POCUS revealed bladder volumes of 400 mL with an inability to void. Fifteen minutes later, their bladder volumes increased to 650 mL, prompting the insertion of indwelling catheters. An initial 800 mL of urine was drained, followed by two additional 800 mL outputs in the ward. These findings highlight that patients who receive intraoperative diuretics are at elevated risk for POUR due to rapid urine production and should be preemptively evaluated for catheterization needs [15]. Taken together with clinical observations (see Fig. 3 ), these results underscore that POUR risk should not be overlooked, even in minor gynecologic procedures. Early bladder function assessment in the post-anesthesia care unit (PACU) using POCUS can facilitate timely interventions, ensuring patient safety through individualized management strategies. Accurate Postoperative Bladder Volume Monitoring and Management via POCUS Previous studies have indicated that bladder volumes exceeding 150 mL generally trigger the urge to void in healthy adults [8]. Therefore, postoperative POCUS-based bladder volume assessment provides a reliable basis for symptom interpretation and intervention. If bladder volume is below 150 mL, urinary urgency is often attributable to urethral irritation from intraoperative catheterization. These patients typically present with discomfort in the urethral region, which improves significantly following psychological reassurance, distraction techniques, or non-pharmacological measures. When bladder volume falls within 150–600 mL, encouraging spontaneous voiding is advisable. Note that some patients may find it difficult to urinate while supine; assuming a seated or squatting position can often facilitate voiding. In PACU or monitored settings, when offering voiding opportunities, clinicians must also guard against posture-induced hypotension or falls. For patients with bladder volumes > 600 mL, active intervention is warranted. Techniques such as applying warm water, adjusting body position, or exposing patients to running water sounds may promote urination. If these fail, timely intermittent catheterization should be performed to prevent detrusor dysfunction and prolonged postoperative voiding difficulties [15]. Detection of Incomplete Voiding via POCUS Our study also identified that some patients with a history of urinary frequency or urgency exhibited incomplete voiding after surgery. Although they reported subjective resolution of the urge, POCUS revealed post-void residual volumes ranging from 50–200 mL, indicating subclinical urinary retention. Such patients often required multiple voiding attempts to achieve full bladder emptying [16]. Additionally, some studies suggest discrepancies between subjective symptoms and objective assessments, underscoring the need to integrate patient-reported outcomes with imaging confirmation to avoid overlooking latent urinary retention or secondary infections [17]. While the sample size in our study was limited, the preliminary findings highlight the utility of POCUS in dynamic postoperative bladder monitoring. This technique enables accurate evaluation of bladder fullness and helps identify voiding dysfunctions, ultimately facilitating optimized recovery pathways. Conclusion Point-of-care ultrasonography (POCUS), as a non-invasive and real-time imaging modality, can be effectively and efficiently implemented by anesthesiologists and nursing staff after appropriate training. Through interdisciplinary collaboration, POCUS allows for rapid and accurate identification of the underlying causes of postoperative urinary discomfort in gynecologic patients—particularly in cases of reported urinary urgency. Timely assessment of bladder volume enables targeted intervention and individualized care strategies. The application of POCUS significantly enhances postoperative management efficiency in the recovery phase and improves overall patient outcomes. Its integration into postoperative care in the PACU should be promoted as a key component of enhanced recovery protocols. Abbreviations POCUS: Point-of-care ultrasound; POUR: Postoperative urinary retention; PACU: Post-anesthesia care unit; GA: General anesthesia; BMI: Body mass index; US: Ultrasound; OR: Operating room; LRH: Laparoscopic radical hysterectomy; MSE: Mean squared error; SPSS: Statistical Package for the Social Sciences; IU: International units; mL: Milliliter; min: Minutes. Declarations Consent for publication: Not applicable. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Further information is available from the corresponding author upon reasonable request. Ethics Approval and Consent to Participate: This study was approved by the Institutional Review Board of First Affiliated Hospital of Sun Yat-sen University (Approval No. Lun Shen [2022] No. 633). Written informed consent was obtained from all participants prior to inclusion in the study. The study was conducted in accordance with the Declaration of Helsinki. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by the Guangdong Provincial Department of Education Project: Development of a Perioperative Point-of-Care Ultrasound Online Course (Grant No. JXJYGC2022GX265). The funding body had no involvement in the study design, data collection, analysis, interpretation, or manuscript preparation. Authors' contributions: X.Q.Y. (Yaoxqin Yao) conceived the study and served as the corresponding author. Q.F.Z. (Qiongfang Zhu), J.X.L. (Jiaxin Liu) and T.T.G. (Tiantian Gan) contributed to data collection and interpretation. Y.B.K. (Yubo Kang) and Q.M.M. (Qiaomei Ma) performed statistical analysis. J.Y.T. (Jiayu Tan) drafted the manuscript and assisted with literature review. All authors reviewed and approved the final version of the manuscript. Acknowledgements: We would like to thank the staff at the Surgical Anesthesia Center, The First Affiliated Hospital of Sun Yat-sen University, for their collaboration and support throughout the course of this study. Special thanks to the patients and nursing team for their active participation and cooperation during the ultrasound evaluations. References Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography. N Engl J Med. 2021;385(17):1593–602. https://doi.org/10.1056/NEJMra1916062 The Paper. Guangdong establishes its first precision anesthesia branch, making patients less fearful of seeking care 2020. Available from: https://m.thepaper.cn/baijiahao_10594824 Lu YL, Li SS, Li X, Wu P, Wan C, Wang PH, Yu JH, Zeng Y, Wang SH, Yang SH. Best evidence summary for the prevention and management of urinary retention after radical surgery in cervical cancer patients. Chin J Nurs. 2019;54(7):1097–102. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–57. https://doi.org/10.1056/NEJMra0909487 Ramsingh D, Bronshteyn YS, Haskins S, Zimmerman J. Perioperative point-of-care ultrasound: From concept to application. Anesthesiology. 2020;132(4):908–16. https://doi.org/10.1097/ALN.0000000000003113 O'Brian RA, Firan A, Sheridan MJ, Kou M, Place RC, Chung CH. Bladder point-of-care ultrasound: A time saver in the pediatric emergency department. J Emerg Med. 2021;61(3):e32–e9. https://doi.org/10.1016/j.jemermed.2021.04.010 Cao L, Zhang LN, Sun Y, Tian D, Zhong P, Yang Q. Application of bedside ultrasound in bladder assessment of critically ill patients. Clin J Med Offic. 2022;37(9):834–7. Ozturk NK, Kavakli AS. Use of bladder volume measurement assessed with ultrasound to predict postoperative urinary retention. North Clin Istanb. 2016;3(3):209–16. https://doi.org/10.14744/nci.2016.03164 Araklitis G, Paganotto M, Hunter J, Thiagamoorthy G, Robinson D, Cardozo L. Can we replace the catheter when evaluating urinary residuals? Neurourol Urodyn. 2019;38(4):1100–5. https://doi.org/10.1002/nau.23963 Kelly CE. Evaluation of voiding dysfunction and measurement of bladder volume. Rev Urol. 2004;6(S1):S32–7. Plöger R, Behning C, Walter A, Gembruch U, Strizek B, Recker F. Diagnoses of postpartum urinary retention using next-generation non-piezo ultrasound technology: Assessing the accuracy and benefits. Sci Rep. 2024;14(1):31844. https://doi.org/10.1038/s41598-024-83160-6 Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: Anesthetic and perioperative considerations. Anesthesiology. 2009;110(5):1139–57. https://doi.org/10.1097/ALN.0b013e31819f7aea Wang WZ, Zhang SY, Shuang WB. Causes and perioperative management of urinary retention after extensive hysterectomy. Chin J Reprod Health. 2022;33(2):198–200. Kandadai P, Saini J, Patterson D, O'Dell K, Flynn M. Urinary retention after hysterectomy and postoperative analgesic use. Female Pelvic Med Reconstr Surg. 2015;21(5):257–62. https://doi.org/10.1097/spv.0000000000000151 Siedhoff MT, Wright KN, Misal MA, Molina AL, Greene NH. Postoperative urinary retention after benign gynecologic surgery with a liberal versus strict voiding protocol. J Minim Invasive Gynecol. 2021;28(2):351–7. https://doi.org/10.1016/j.jmig.2020.07.002 Alpert EA, Gold DD, Kobliner-Friedman D, Wagner M, Dadon Z. Revolutionizing bladder health: Artificial-intelligence-powered automatic measurement of bladder volume using two-dimensional ultrasound. Diagnostics. 2024;14(16):1829. https://doi.org/10.3390/diagnostics1416 Tessi C, Burek CM, Sager C, Szklarz MT, Vásquez M, López Imizcoz F, Ruiz J, Weller S, Gomez Y, Corbetta JP. Bladder volume assessment in pediatric patients with neurogenic bladder: Is ultrasound an accurate method? Urology. 2021;147:250–5. https://doi.org/10.1016/j.urology.2020.10.005 Additional Declarations No competing interests reported. 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Patients\u003c/p\u003e","description":"","filename":"Figure3.RelationshipBetweenUltrasoundMeasuredBladderVolumeandUrinationin325Patients.png","url":"https://assets-eu.researchsquare.com/files/rs-7293057/v1/4b0785d21724a23fb1b4a3b8.png"},{"id":91195359,"identity":"e852dd1e-9b79-4a5a-8fda-1ad3c91eb3ca","added_by":"auto","created_at":"2025-09-12 14:56:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145220,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7293057/v1/5e54064b-98e2-4f45-a062-4894f1bd5fa0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of Point-of-Care Ultrasound in Predicting Spontaneous Voiding in Postoperative Gynecological Patients with Urinary Urgency After General Anesthesia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2011, the United States launched the \u0026ldquo;Precision Medicine\u0026rdquo; initiative, promoting a shift in medical practice toward individualized and refined care [1]. In 2020, Guangdong Province established the first \u0026ldquo;Precision Anesthesia\u0026rdquo; subcommittee, marking the deep integration of precision concepts into the field of anesthesia [2]. Precision anesthesia encompasses accurate anesthetic monitoring, drug administration, fluid management, and postoperative recovery management\u0026mdash;most of which are carried out in the Post-Anesthesia Care Unit (PACU). This phase is crucial for ensuring patient safety and promoting rapid recovery after surgery [3]. That same year, Moore et al. introduced the concept of \u0026ldquo;Point-of-Care Ultrasonography\u0026rdquo; (POCUS) in \u003cem\u003eThe New England Journal of Medicine\u003c/em\u003e, emphasizing its significant value in perioperative care [4]. In recent years, with advancements in ultrasound visualization technology, POCUS has become an integral part of precision anesthesia. It allows for rapid intraoperative and postoperative assessments, assisting clinicians in making qualitative, localized, time-sensitive, and quantitative diagnostic decisions, thereby improving the efficiency and safety of perioperative management. Literature reports [5] indicate that POCUS is now widely used in intensive care and postoperative management, particularly for bladder function assessment. For patients with indwelling urinary catheters, POCUS can be used to measure bladder volume in real time, detect urinary retention, assess catheter patency, locate catheter position, and guide catheterization procedures and timing. This facilitates early catheter removal and helps prevent complications such as catheter-associated urinary tract infections. POCUS offers several advantages\u0026mdash;non-invasiveness, ease of use, and intuitive results\u0026mdash;which make it especially suitable for patients who are conscious postoperatively but experience a sense of urgency to urinate. It is of significant clinical value in identifying the cause of urinary urgency, assessing the ability to urinate spontaneously, and evaluating the risk of urinary retention [6]. This study aims to explore the application value of POCUS in predicting spontaneous voiding ability in gynecologic surgery patients who report urinary urgency during the PACU recovery period. The goal is to provide an objective basis for decisions regarding postoperative catheterization and to optimize bladder management strategies.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch2\u003eGeneral Information\u003c/h2\u003e\n\u003cp\u003eFrom January 2022 to June 2024, a total of 50 patients who underwent general anesthesia for gynecologic surgery and recovered in the PACU were enrolled. All patients met the American Society of Anesthesiologists (ASA) Physical Status Classification I\u0026ndash;III, reported postoperative urinary urgency, and had no indwelling urinary catheter. The patients had a mean age of 35.66 \u0026plusmn; 8.93 years and a body mass index of 21.94 \u0026plusmn; 3.29 kg/m\u0026sup2;. Among them, 24 received general anesthesia with tracheal intubation and 26 received intravenous anesthesia. The average surgery duration was 85.07 \u0026plusmn; 60.2 minutes, and the average fluid input was 769.40 \u0026plusmn; 519.95 mL. Informed consent was obtained from all participants, and the study was approved by the institutional ethics committee.\u003c/p\u003e\n\u003ch2\u003eMethods\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Subjects\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003ePatients who underwent general anesthesia and were sent to the PACU with a tracheal tube had the tube removed once extubation criteria were met; patients who underwent intravenous anesthesia were directly sent to the PACU for observation. Sedation was maintained at a Richmond Agitation-Sedation Scale (RASS) score of 0 to +1. During recovery, for patients without indwelling catheters but complaining of urinary urgency, a self-controlled method was used: physical examination followed by POCUS assessment. Physical examination involved percussion over the suprapubic region to determine whether a dull sound indicated bladder distension. POCUS examinations were performed by anesthesia nurses trained in a standardized protocol. The bladder was scanned above the pubic symphysis using a moving probe to obtain the maximal transverse and longitudinal cross-sections. Three bladder diameters were measured\u0026mdash;transverse, vertical, and anteroposterior\u0026mdash;and bladder volume was calculated using the commonly used formula: V (mL) = transverse \u0026times; anteroposterior \u0026times; vertical \u0026times; 0.52 [7]\u0026nbsp;(see Figures 1\u0026ndash;2).\u003c/p\u003e\n\u003cp\u003eThe calculated value represents bladder volume. The findings from percussion and POCUS assessments were then compared with the patient\u0026apos;s actual urination outcome to analyze the correlation between the assessment methods, symptoms, and clinical results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservation Indicators\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe criteria for physical examination were as follows: percussion over the area superior to the pubic symphysis producing a tympanic sound was considered positive, while a dull sound was considered negative.\u003c/p\u003e\n\u003cp\u003eThe POCUS assessment criterion was based on bladder volume: when the bladder volume exceeded 150 mL, a sensation of urgency to urinate typically occurred [8], which is regarded as the clinical threshold for the onset of micturition desire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eBladder volumes were calculated using Formula 1 and Formula 2. For patients whose POCUS-assessed bladder volume was \u0026ge;150 mL, spontaneous voiding was encouraged. The occurrence of urination within 15 minutes post-assessment was observed. Actual urine output was recorded and compared with the estimated bladder volume from ultrasound, in order to evaluate the consistency between the two.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Control\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAfter the initial POCUS examination was performed by trained nursing staff, all ultrasound findings were independently reviewed and verified by attending or senior anesthesiologists certified in POCUS, ensuring accuracy and consistency in image interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAll statistical analyses were conducted using SPSS version 27.0. Descriptive statistics were applied for data summarization. Continuous variables were expressed as mean \u0026plusmn; standard deviation (x̄ \u0026plusmn; s), while categorical variables were presented as frequencies and percentages (n, %). The correlation between the bladder volume estimated by the two formulas and the actual voided volume was analyzed using the mean squared error (MSE) method to assess agreement and predictive validity.\u003c/p\u003e"},{"header":"Result","content":"\u003ch2\u003eComparison of Two Examination Results of the Patient\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe comparison between percussion and ultrasound results is shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong style='font-weight: 700; color: rgb(0, 0, 0); font-family: \"Times New Roman\"; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;'\u003eTable 1 Comparison of Two Examination Results of the Patient (n=50, x\u0026plusmn;s)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003eTotal (n=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ePositive (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNegative (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003ePositive Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003eFalse Negative Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ePercussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e34.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e62.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: The false negative rate refers to the proportion of cases where the test result is negative but the patient actually has urinary retention.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eDistribution of Patient Urination Time\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe postoperative spontaneous urination times of patients are summarized in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Distribution of Patient Urination Time (n = 50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 57px;\"\u003e\n \u003cp\u003eSpontaneous Urination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 19px;\"\u003e\n \u003cp\u003eInability to Urinate Spontaneously\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt; 15 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15-30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e30-60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eNumber of Patients (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 19px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 57px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Patients who are still unable to urinate spontaneously within 1 hour postoperatively require further assessment of urination function.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eBladder Volume Distribution by POCUS Scan (n=50)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eBladder Volume Distribution by POCUS Scan (n=50)\u003c/p\u003e\n\u003cp\u003eThe distribution of bladder volumes measured by POCUS is presented in Table 3.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;150 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e150~600 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026gt;600 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003eNumber of Patients (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: Clinically, 150 mL is often considered the preliminary threshold for urination stimulus. Volumes over 600 mL suggest a significant risk of bladder overdistension. POCUS (Point-of-Care Ultrasound) refers to bedside ultrasound examination.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAnalysis of the Relationship Between Spontaneous Urination and Patient Data\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe relationship between bladder volume and spontaneous urination time is shown in Table 4. The association between bladder volume measured by ultrasound and spontaneous urination is illustrated in Fig. 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Analysis of the Relationship Between Spontaneous Urination and Patient Data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSpontaneous Urination\u0026nbsp;\u003cbr\u003e\u0026nbsp;(N1 = 11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInability to Urinate\u0026nbsp;\u003cbr\u003e\u0026nbsp;Spontaneously (N2 = 39)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge / Median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.00 [11.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.00 [13.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e265.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.65 \u0026plusmn; 3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.74 \u0026plusmn; 3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration of Surgery (min) / Median (Min-Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.00 (25.00\u0026ndash;150.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60.00 (30.00\u0026ndash;330.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration in Recovery (min) / Median (Min-Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60.00 (40.00\u0026ndash;120.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60.00 (35.00\u0026ndash;260.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntraoperative Fluid Volume (mL) / Median (Min-Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e650.00 (200.00\u0026ndash;1700.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e700.00 (150.00\u0026ndash;3100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e208.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePACU Fluid Volume (mL) / Median (Min-Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00 (0.00\u0026ndash;1000.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00 (0.00\u0026ndash;500.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePercussion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNegative n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePositive n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (17.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29 (82.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBladder Volume (mL) / Median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e300.14 \u0026plusmn; [147.97]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e175.81 \u0026plusmn; [230.84]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Intergroup comparisons were conducted using nonparametric testing (Mann\u0026ndash;Whitney U test). The results suggest that bladder volume is a significant factor influencing postoperative spontaneous urination ability (P \u0026lt; 0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePOCUS-Assisted Evaluation of the True Etiology Behind Subjective Urinary Urgency\u003c/h2\u003e\u003cp\u003eFor minor gynecologic procedures such as hysteroscopy, cervical conization, Bartholin\u0026rsquo;s gland abscess drainage, and suction curettage, intraoperative single-catheterization is frequently performed due to surgical manipulation in the lower abdomen. Postoperatively, some patients may report urinary urgency; however, this symptom can be multifactorial. It may stem from urethral irritation due to catheterization or from true bladder distention. Nevertheless, patients often struggle to distinguish between uterine cramping and bladder fullness and may misinterpret lower abdominal discomfort as urinary urgency, resulting in diagnostic inaccuracies [9]. In this study, POCUS revealed that 38% of patients reporting urinary urgency had bladder volumes less than 150 mL\u0026mdash;some even just a few dozen milliliters\u0026mdash;indicating that the symptom likely originated from urethral irritation rather than actual urinary retention. This could be associated with intraoperative catheterization and localized postoperative tissue stimulation. Therefore, POCUS proves effective in differentiating between urethral irritation and true bladder filling, minimizing misdiagnosis [10]. Additionally, the study observed that physical percussion typically fails to elicit tympanic sounds when the bladder volume is below 300 mL. When volumes exceed 500 mL, percussion or palpation often causes significant discomfort. This issue is particularly pronounced in obese patients, where increased abdominal fat can attenuate percussion sounds, resulting in a higher risk of false negatives. Compared with traditional physical examination, POCUS offers a non-invasive, bedside imaging modality that enables real-time, objective, and accurate evaluation of bladder volume, thus enhancing early detection of postoperative urinary retention (POUR) [11].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eClinical Risk of POUR After Minor Gynecologic Surgery\u003c/h2\u003e\u003cp\u003ePostoperative urinary retention (POUR) is a common complication after anesthesia and surgery, with reported incidence rates ranging from 5\u0026ndash;70% [12]. If not managed promptly, POUR can lead to bladder overdistension, detrusor dysfunction, bladder injury, and even urinary tract infections. Gynecologic procedures, being pelvic in nature, are closely associated with the risk of POUR. Previous studies have shown that the incidence of POUR after total hysterectomy ranges from 3.8\u0026ndash;21.0% internationally, and from 7.55\u0026ndash;44.9% in Chinese literature [13]. Laparoscopic radical hysterectomy (LRH), due to its complexity and risk of nerve injury, has a reported POUR incidence of 2.6\u0026ndash;44.9% [13]. Normal bladder capacity ranges from 400 to 600 mL. Some studies suggest that early detection of urinary retention within 1\u0026ndash;2 hours postoperatively\u0026mdash;even when bladder volumes reach 500\u0026ndash;1000 mL\u0026mdash;does not necessarily impair long-term bladder function [14]. However, other studies recommend catheterization when bladder volumes exceed 600 mL to prevent further complications. Although there is limited systematic research on POUR after minor gynecologic procedures such as hysteroscopy or conization, our study identified associated risks. For example, two patients who underwent hysteroscopy were administered intravenous furosemide (10 mg and 20 mg, respectively) during surgery and received single catheterization upon completion. In the recovery room, both reported urinary urgency. POCUS revealed bladder volumes of 400 mL with an inability to void. Fifteen minutes later, their bladder volumes increased to 650 mL, prompting the insertion of indwelling catheters. An initial 800 mL of urine was drained, followed by two additional 800 mL outputs in the ward. These findings highlight that patients who receive intraoperative diuretics are at elevated risk for POUR due to rapid urine production and should be preemptively evaluated for catheterization needs [15].\u003c/p\u003e\u003cp\u003eTaken together with clinical observations (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e), these results underscore that POUR risk should not be overlooked, even in minor gynecologic procedures. Early bladder function assessment in the post-anesthesia care unit (PACU) using POCUS can facilitate timely interventions, ensuring patient safety through individualized management strategies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAccurate Postoperative Bladder Volume Monitoring and Management via POCUS\u003c/h2\u003e\u003cp\u003ePrevious studies have indicated that bladder volumes exceeding 150 mL generally trigger the urge to void in healthy adults [8]. Therefore, postoperative POCUS-based bladder volume assessment provides a reliable basis for symptom interpretation and intervention. If bladder volume is below 150 mL, urinary urgency is often attributable to urethral irritation from intraoperative catheterization. These patients typically present with discomfort in the urethral region, which improves significantly following psychological reassurance, distraction techniques, or non-pharmacological measures. When bladder volume falls within 150\u0026ndash;600 mL, encouraging spontaneous voiding is advisable. Note that some patients may find it difficult to urinate while supine; assuming a seated or squatting position can often facilitate voiding. In PACU or monitored settings, when offering voiding opportunities, clinicians must also guard against posture-induced hypotension or falls. For patients with bladder volumes\u0026thinsp;\u0026gt;\u0026thinsp;600 mL, active intervention is warranted. Techniques such as applying warm water, adjusting body position, or exposing patients to running water sounds may promote urination. If these fail, timely intermittent catheterization should be performed to prevent detrusor dysfunction and prolonged postoperative voiding difficulties [15].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eDetection of Incomplete Voiding via POCUS\u003c/h2\u003e\u003cp\u003eOur study also identified that some patients with a history of urinary frequency or urgency exhibited incomplete voiding after surgery. Although they reported subjective resolution of the urge, POCUS revealed post-void residual volumes ranging from 50\u0026ndash;200 mL, indicating subclinical urinary retention. Such patients often required multiple voiding attempts to achieve full bladder emptying [16].\u003c/p\u003e\u003cp\u003eAdditionally, some studies suggest discrepancies between subjective symptoms and objective assessments, underscoring the need to integrate patient-reported outcomes with imaging confirmation to avoid overlooking latent urinary retention or secondary infections [17]. While the sample size in our study was limited, the preliminary findings highlight the utility of POCUS in dynamic postoperative bladder monitoring. This technique enables accurate evaluation of bladder fullness and helps identify voiding dysfunctions, ultimately facilitating optimized recovery pathways.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePoint-of-care ultrasonography (POCUS), as a non-invasive and real-time imaging modality, can be effectively and efficiently implemented by anesthesiologists and nursing staff after appropriate training. Through interdisciplinary collaboration, POCUS allows for rapid and accurate identification of the underlying causes of postoperative urinary discomfort in gynecologic patients\u0026mdash;particularly in cases of reported urinary urgency. Timely assessment of bladder volume enables targeted intervention and individualized care strategies. The application of POCUS significantly enhances postoperative management efficiency in the recovery phase and improves overall patient outcomes. Its integration into postoperative care in the PACU should be promoted as a key component of enhanced recovery protocols.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePOCUS: Point-of-care ultrasound; POUR: Postoperative urinary retention; PACU: Post-anesthesia care unit; GA: General anesthesia; BMI: Body mass index; US: Ultrasound; OR: Operating room; LRH: Laparoscopic radical hysterectomy; MSE: Mean squared error; SPSS: Statistical Package for the Social Sciences; IU: International units; mL: Milliliter; min: Minutes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this published article. Further information is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Institutional Review Board of First Affiliated Hospital of Sun Yat-sen University (Approval No. Lun Shen [2022] No. 633). Written informed consent was obtained from all participants prior to inclusion in the study. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by the Guangdong Provincial Department of Education Project: Development of a Perioperative Point-of-Care Ultrasound Online Course (Grant No. JXJYGC2022GX265). The funding body had no involvement in the study design, data collection, analysis, interpretation, or manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eX.Q.Y. (Yaoxqin Yao) conceived the study and served as the corresponding author. Q.F.Z. (Qiongfang Zhu), J.X.L. (Jiaxin Liu) and T.T.G. (Tiantian Gan) contributed to data collection and interpretation. Y.B.K. (Yubo Kang) and Q.M.M. (Qiaomei Ma) performed statistical analysis. J.Y.T. (Jiayu Tan) drafted the manuscript and assisted with literature review. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe would like to thank the staff at the Surgical Anesthesia Center, The First Affiliated Hospital of Sun Yat-sen University, for their collaboration and support throughout the course of this study. Special thanks to the patients and nursing team for their active participation and cooperation during the ultrasound evaluations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eD\u0026iacute;az-G\u0026oacute;mez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography. N Engl J Med. 2021;385(17):1593\u0026ndash;602. https://doi.org/10.1056/NEJMra1916062\u003c/li\u003e\n\u003cli\u003eThe Paper. Guangdong establishes its first precision anesthesia branch, making patients less fearful of seeking care 2020. Available from: https://m.thepaper.cn/baijiahao_10594824\u003c/li\u003e\n\u003cli\u003eLu YL, Li SS, Li X, Wu P, Wan C, Wang PH, Yu JH, Zeng Y, Wang SH, Yang SH. Best evidence summary for the prevention and management of urinary retention after radical surgery in cervical cancer patients. Chin J Nurs. 2019;54(7):1097\u0026ndash;102. \u003c/li\u003e\n\u003cli\u003eMoore CL, Copel JA. Point-of-care ultrasonography. 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Anesthesiology. 2009;110(5):1139\u0026ndash;57. https://doi.org/10.1097/ALN.0b013e31819f7aea\u003c/li\u003e\n\u003cli\u003eWang WZ, Zhang SY, Shuang WB. Causes and perioperative management of urinary retention after extensive hysterectomy. Chin J Reprod Health. 2022;33(2):198\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eKandadai P, Saini J, Patterson D, O\u0026apos;Dell K, Flynn M. Urinary retention after hysterectomy and postoperative analgesic use. Female Pelvic Med Reconstr Surg. 2015;21(5):257\u0026ndash;62. https://doi.org/10.1097/spv.0000000000000151\u003c/li\u003e\n\u003cli\u003eSiedhoff MT, Wright KN, Misal MA, Molina AL, Greene NH. Postoperative urinary retention after benign gynecologic surgery with a liberal versus strict voiding protocol. J Minim Invasive Gynecol. 2021;28(2):351\u0026ndash;7. https://doi.org/10.1016/j.jmig.2020.07.002\u003c/li\u003e\n\u003cli\u003eAlpert EA, Gold DD, Kobliner-Friedman D, Wagner M, Dadon Z. Revolutionizing bladder health: Artificial-intelligence-powered automatic measurement of bladder volume using two-dimensional ultrasound. Diagnostics. 2024;14(16):1829. https://doi.org/10.3390/diagnostics1416\u003c/li\u003e\n\u003cli\u003eTessi C, Burek CM, Sager C, Szklarz MT, V\u0026aacute;squez M, L\u0026oacute;pez Imizcoz F, Ruiz J, Weller S, Gomez Y, Corbetta JP. Bladder volume assessment in pediatric patients with neurogenic bladder: Is ultrasound an accurate method? Urology. 2021;147:250\u0026ndash;5. https://doi.org/10.1016/j.urology.2020.10.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bedside ultrasonography, Gynecological surgery, General anesthesia, Urinary retention, Prediction of spontaneous voiding","lastPublishedDoi":"10.21203/rs.3.rs-7293057/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7293057/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo explore the application value of point-of-care ultrasound (POCUS) in evaluating postoperative gynecological patients who complain of urinary urgency during the recovery period after general anesthesia, to clarify the cause of urgency, identify the risk of urinary retention, and provide a reference for catheterization decisions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 50 postoperative patients who experienced urinary urgency without indwelling catheters were assessed using both physical percussion and POCUS to estimate bladder volume. The examination results and subsequent voiding outcomes were recorded. The positive rates and false-negative rates of both methods were compared, and the association between spontaneous voiding ability and bladder volume, percussion findings, and perioperative variables was analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe positive rate of POCUS was 62.00%, significantly higher than that of physical percussion at 34.00% (P\u0026thinsp;=\u0026thinsp;0.01), with a false-negative rate of 28% for percussion. Within 60 minutes postoperatively, 31 patients voided spontaneously. Based on ultrasound assessment, 19 patients had bladder volumes\u0026thinsp;\u0026lt;\u0026thinsp;150 ml, 26 had volumes between 150\u0026ndash;600 ml, and 5 had volumes\u0026thinsp;\u0026gt;\u0026thinsp;600 ml. Patients who voided had a median bladder volume of 300.14 ml, significantly higher than 175.81 ml in those who did not (P\u0026thinsp;=\u0026thinsp;0.030). Spontaneous voiding was significantly associated with bladder volume. Other factors such as age, BMI, duration of surgery and recovery, and intraoperative and recovery fluid volumes were not significantly associated with spontaneous voiding (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePostoperative spontaneous voiding ability is closely related to bladder volume. POCUS demonstrates superior sensitivity and accuracy compared to physical percussion in identifying the risk of urinary retention. Early intervention guided by POCUS provides an objective basis for postoperative catheterization decisions.\u003c/p\u003e","manuscriptTitle":"Application of Point-of-Care Ultrasound in Predicting Spontaneous Voiding in Postoperative Gynecological Patients with Urinary Urgency After General Anesthesia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 14:32:50","doi":"10.21203/rs.3.rs-7293057/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"12289454607132555915440091798435956766","date":"2025-09-07T19:36:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T16:14:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-14T19:55:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T11:18:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T11:18:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2025-08-04T15:57:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"01a2b02a-a0ec-449b-83dd-6d924428495b","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-12T14:32:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-12 14:32:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7293057","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7293057","identity":"rs-7293057","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}