Diagnosis of Postoperative Urinary Retention Using

a Simplified Ultrasound Bladder Measurement

Aurélien Daurat, MD,* Olivier Choquet, MD,* Sophie Bringuier, PharmD, PhD,†
Jonathan Charbit, MD,* Michael Egan, MD,* and Xavier Capdevila, MD, PhD*

BACKGROUND: In this study, we sought to determine whether a simplified ultrasound measure-

ment of the largest transverse diameter, using a standard ultrasound machine, could be used
to diagnose postoperative urinary retention (POUR). This method may replace expensive bladder
volume measuring devices or a more complex ultrasound procedure (involving the measurement
of 3 bladder diameters).
METHODS: Patients at risk of POUR if unable to void after orthopedic surgery were evaluated
in the postanesthesia care unit before discharge. Bladder diameter was first measured using a
portable ultrasound device (Vscan®; GE Healthcare, Wauwatosa, WI). An automated evaluation of
bladder volume was then performed (Bladderscan® BVI 3000; Diagnostic Ultrasound, Redmond,
WA). Finally, when a bladder catheterization was performed, the actual urinary volume was mea-
sured. The main outcome was a bladder volume ≥600 mL as measured using the automated
ultrasound scanner (Bladderscan BVI 3000) or by catheterization. Correlations between bladder
volumes and diameter were studied and receiver operating characteristic curves were constructed
to determine the performance in predicting a bladder volume ≥600 mL. A “gray zone” approach
was developed because a single cutoff value may not always be clinically significant.
RESULTS: One hundred patients were included and underwent a Bladderscan measurement.
Urinary volume after catheterization was obtained in 49 patients. A significant correlation was
found between the largest transverse diameter and urinary volumes assessed by the 2 meth-
ods (Bladderscan and catheterization). Pearson correlation coefficients were r = 0.80 (95%
confidence interval [CI], 0.72–0.86; P < 0.001) and r = 0.79 (95% CI, 0.65–0.88; P < 0.001),
respectively. The area under the receiver operating characteristic curves for the prediction of
a bladder volume ≥600 mL were 0.94 (95% CI, 0.88–0.98) and 0.91 (95% CI, 0.79–0.97),
respectively, for urinary volumes assessed by Bladderscan and catheterization. The optimal
cutoff value was 9.7 cm for both methods. The gray zone was narrow, ranging from 9.7 to 10.7
cm thus limiting inconclusive measurements.
CONCLUSIONS: A simple ultrasound measurement of the largest transverse bladder diameter
seemed to be helpful to exclude or confirm POUR.  (Anesth Analg 2015;XXX:00–00)

P
ostoperative urinary retention (POUR) is an overdis-
tention of the bladder that occurs frequently in the
postoperative period. It can lead to both local and
general complications, such as infection, delirium, detrusor
muscle damage,1 or even cardiac arrhythmia,2 and also may
delay hospital discharge.3 Because this adverse event pri-
marily affects patients with risk factors,4,5 screening of such
patients is recommended after surgery.6
Real-time ultrasonography may provide a reliable esti-
mation of bladder volume. However, it is a technically
demanding procedure, involving the measurement of 3
diameters (transverse, anteroposterior, and superoinfe-
rior) in 2 different planes (transverse and sagittal) and
the application of a proportionality constant.7 Specific
*Department of Anesthesia and Critical Care Medicine, Lapeyronie Uni-
versity Hospital, Montpellier, France; and †Departments of Anesthesia and
Critical Care Medicine and Biostatistics, Lapeyronie University Hospital,
Montpellier, France.
Accepted for publication October 31, 2014.
Funding: Institutional Funding.
The authors declare no conflicts of interest.
This report was previously presented, in part, at the Congres de la SFAR 2012.
Reprints will not be available from the authors.
Address correspondence to Aurélien Daurat, MD, Department of Anesthesia
and Critical Care Medicine, Lapeyronie University Hospital, 5 rue Nozeran
34090 Montpellier, France. Address e-mail to a-daurat@chu-montpellier.fr.
Copyright © 2015 International Anesthesia Research Society
DOI: 10.1213/ANE.0000000000000595
automated bladder ultrasound devices that measure blad-
der volumes have been developed to facilitate the diag-
nosis of POUR. Indeed, several studies have confirmed
their high degree of accuracy compared with actual urine
volumes obtained after bladder emptying.8 Nonetheless,
these devices remain costly and often are not readily
available.
During the past 10 years, medical professionals have
continued to expand the clinical applications of ultrasound.
This is especially true in the field of anesthesia, and ultra-
sound devices are now readily available in most centers.
This raises the question of the need to continue to rely on
specific expensive devices.
The aim of this study was to determine whether a sim-
plified ultrasound measurement of the largest transverse
diameter using a standard ultrasound device could reliably
diagnose POUR.
METHODS
Design
After ethical review board approval (Comité de Protection
des Personnes Sud Méditerranée III, Nîmes, France) and
registration in the French Database for Clinical Trials (ID
RCB number: 2013-A00757-38), a prospective observational
study was performed from July to October 2013 in the ortho-
pedic surgery unit of a tertiary university hospital. Written
informed patient consent was obtained preoperatively.

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 Simplified Ultrasound Bladder Measurement
Patients
All postoperative patients with at least one of the follow-
ing risk factors for POUR immediately after surgery, i.e., age
≥50 years, male sex, prostate adenoma, surgery ≥60 min-
utes, IV fluids ≥750 mL intraoperatively, spinal anesthesia,
and IV morphine, were evaluated immediately before dis-
charge from the postanesthesia care unit (PACU) if unable
to void, as has been recommended.2 Patients younger than
18 years of age, patient refusal, those already included in
another study, or those who received only peripheral nerve
blockade were excluded.
Measurements
A small portable ultrasound device (Vscan®; GE
Healthcare, Wauwatosa, WI) with a low-frequency trans-
ducer (from 1.7 to 3.8 Hz) was used. The largest trans-
verse bladder diameter was measured in the PACU by a
nurse not involved in the care of the particular patient.
The probe was positioned directly above the pubis (Fig. 1,
A), and after visualization of the largest transversal image
of the bladder, the screen was frozen and the largest
transverse diameter measured (Fig. 1, B). The axis used
to obtain the largest transverse diameter was left to the
discretion of the operator.
To assess the reproducibility of this measurement, the
first author, who was blinded to the nurse’s findings, per-
formed a second measurement on a subset of patients.
Volume assessment of the bladder was then performed
using an automated bladder ultrasound scanner accord-
ing to the manufacturer’s instructions (Bladderscan® BVI
3000; Diagnostic Ultrasound, Redmond, WA) by a nurse
also blinded to the result of the initial transverse diameter
measurement. Finally, when a bladder catheterization was
performed, the actual urinary volume was measured.
Nurse Training
All PACU nurses from the unit were provided with brief
training in the use of ultrasonography before the study,
which included a 30-minute explanatory review and a ses-
sion of practical application.
Figure 1. Ultrasound measurement of the largest transverse diameter. A, The probe was positioned above the pubis forming an angle
of approximately 60° with the anterior abdominal wall; B, after visualization of the largest transversal image, the largest diameter
was measured.
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Catheterization
Catheterization of the urinary bladder was performed in the
PACU according to the ward protocol, that is, if the volume
measured by the Bladderscan was ≥600 mL or if the anesthe-
siologist-in-charge of the patient deemed it necessary (e.g.,
indwelling catheter to monitor urinary output). The main
outcome was a bladder volume of ≥600 mL, as measured
using the automated ultrasound scanner (Bladderscan BVI
3000) or by catheterization.
Analysis
A minimal sample size of 84 patients was calculated to obtain
an area under the receiver operating characteristic curve
(ROC) of 0.75, as recommended by Ray et al.9 The POUR inci-
dence of 25% found in the study by Balderi et al.10 was used
for this calculation. Because all the patients would not be
catheterized, we finally increased this number to 100 patients.
Distribution of continuous variables was tested for nor-
mality using the Shapiro-Wilk test, all P > 0.05 among the
data were considered normally distributed, and these data
were expressed by mean (SD). Nonparametric data were
expressed by median (interquartile range). Comparisons
between groups for parametric continuous data were per-
formed using Student t test. The Pearson correlation coef-
ficient (r) was calculated to examine the relation between
diameter and volume. Because we could not predict a pri-
ori whether the largest bladder diameter was dependent on
the urine volume, and because an empty bladder may have
a diameter >0, we did not use linear regression with forced
intercept of zero for this purpose.
ROCs were constructed to determine the performance
of the largest transverse diameter in predicting a bladder
volume ≥600 mL as measured by the Bladderscan or cath-
eterization. The area under the curve was calculated and
the optimum cutoff assessed using the method reported by
Youden.11 Calculation of the 95% confidence intervals (CIs)
of the different cutoff and of the area under the curve was
performed using the binomial exact method.
Because a single cutoff value may not always be clinically
significant, a “gray zone” approach as described by Ray
anesthesia & analgesia
 et al.9 was adopted. The same method as Cannesson et al.12 urinary volume ≥600 mL compared with those with a uri-
was applied. It was decided a priori that the values associ- nary volume <600 mL: 11.2 (±1.4) vs 8.6 cm (±1.6); P < 0.001.
ated with neither a sensitivity lower than 90% nor a speci- The median bladder volume measured by Bladderscan BVI
ficity inferior to 90% be considered inconclusive, thereby was 350 mL (interquartile range, 212–600), and mean uri-
defining a gray zone of clinical uncertainty. Two cutoff nary volume after catheterization was 572 ± 312 mL.
points of clinical interest were determined for each urinary A significant positive correlation was found between the
volume measurement method (Bladderscan and catheteriza- largest bladder diameter and the urine volume as measured
tion), thus corresponding to the lower and upper limits of by the Bladderscan and after catheterization, respectively, r =
the gray zone. 0.80 (95% CI, 0.72–0.86) and r = 0.79 (95% CI, 0.65–0.88; Fig. 3).
Interobserver reliability between the measures performed ICC between 20 largest transverse diameter measure-
by the principal investigator and the nurses was assessed by ments performed by an investigator and the nurses was 0.92
calculating the intraclass correlation coefficient (ICC) in a sub- (95% CI, 0.82–0.97).
set of patients. An ICC > 0.75 corresponds to a good agreement. The area under the ROC curves for the prediction of a
ICC was calculated using a 2-way mixed-effect model with bladder volume ≥600 mL measured by the Bladderscan or
an absolute agreement definition as described by McGraw catheterization was 0.94 (95% CI, 0.88–0.98, P < 0.001) and 0.91
and Wong13 (for the CI calculation, see the “ICC (A,1)” equa- (95% CI, 0.79–0.97; P < 0.001), respectively (Fig. 4). The best
tion in Table 7 in the study by McGraw and Wong). Statistical cutoff value determined using the Youden method was 9.7
analyses were performed using MedCalc for Windows ver- cm for prediction of a urine volume ≥600 mL measured both
sion 12.5.0.0 (MedCalc Software bvba, Mariakerke, Belgium) by Bladderscan and catheterization. According to predefined
and the R software (version 3.0.2). Results with P values ≤0.05 sensibility and specificity values, the cutoff values determin-
were considered statistically significant. ing the gray zone of clinical uncertainty were the following:
(1) The lower threshold was 9.7 cm for both volume
RESULTS measurement methods. This threshold provided,
Of the 1932 patients who underwent an orthopedic surgi- respectively, for the prediction of a catheterized urine
cal procedure in our unit, 100 patients were eventually volume and a Bladderscan volume ≥600 mL, a sen-
included and received bladder diameter and Bladderscan sitivity of 0.96 (95% CI, 0.79–0.99) and 0.96 (95% CI,
measurement. Urinary volume after catheterization was 0.80–0.99) and a negative predictive value of 0.95
obtained in 49 patients (Fig. 2). Characteristics and intraop- (95% CI, 0.74–0.99) and 0.98 (95% CI, 0.92–1.00).
erative data are listed in Table 1. (2) The greater threshold was 10.7 cm for the urinary
The mean largest diameter was significantly greater in volume after catheterization and 10 cm for the
patients with a Bladderscan ≥600 mL compared with those Bladderscan. Respectively, the specificity values
with a Bladderscan <600 mL: 11.0 (±1.2) vs 8.2 cm (±1.6); associated with these threshold were 0.92 (95% CI,
P < 0.001. It was also larger in patients with a catheterized 0.73–0.99) and 0.93 (95% CI, 0.85–0.98) and the posi-
tive predictive values were 0.87 (95% CI, 0.62–0.98)
1932 patients screened and 0.81 (95% CI, 0.62–0.94).
scheduled for Orthopedic
Surgical Procedure during the
4 months period
Table 1.  Patient Characteristics
Studied variable All patients (n = 100)
1109 patients dropped out Age (years) 70 (58–76)
388 Emergencies Weight (kg) 76 (15)
713 PNB Alone Height (cm) 168 (9)
8 Patients < 18 yr
Sex, female:male (%) 47 (47):53 (53)
Physical status, n (%)
 ASA I 27 (27)
823 patients assessed for
 ASA II 51 (51)
eligibility
 ASA III 20 (20)
 ASA IV 2 (2)
723 patients excluded Type of surgery, n (%)
475 No Risk Factors  Total hip arthroplasty 32 (32)
181 Void within 30 min  Total knee arthroplasty 30 (30)
56 Nurse non available
11 Patients refusal
 Hip fracture 10 (10)
 Others 28 (28)
Type of anesthesia, n (%)
100 patients  General anesthesia 33 (33)
Bladderscan ® and greatest  Neuraxial anesthesia 6 (6)
transverse diameter
 General + peripheral block 61 (61)
measurement
Prostate adenoma, n (%) 5 (5)
Surgery duration (min) 112 (80–180)
IV fluids (mL) 1500 (1500–2500)
51 patients 49 patients Spinal anesthesia, n (%) 6 (6)
No urinary bladder Urinary bladder
IV morphine, n (%) 36 (36)
catheterization catheterization
Data are expressed as mean (SD), median (interquartile range: 25th–75th
Figure 2. Flow diagram. PNB = peripheral nerve blockade. percentile), or number (%).

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 Simplified Ultrasound Bladder Measurement

Figure 3. Correlation between bladder transverse diameter and urine volume assessed using the Bladderscan BVI 3000 (A; n = 100) or
measured by catheterization (B; n = 49).

Figure 4. Receiver operator characteristic curves of the bladder largest transverse diameter in the prediction of a bladder volume ≥600 mL
assessed using the Bladderscan BVI 3000 (A; n = 100) or measured by catheterization (B; n = 49). AUC = area under the curve.

Values of sensitivity, specificity, positive and negative pre-
dictive values, and likelihood ratio for the various thresh-
olds are listed in Table 2.
DISCUSSION
This observational study of 100 patients suggests that
the postoperative measurement of the largest transverse
diameter is an efficient tool for the diagnosis of POUR
in at-risk patients. Indeed, there was good correlation
between this measurement and the urinary volume mea-
sured when Bladderscan BVI 3000 or catheterization
was used (r = 0.80 and r = 0.79, respectively). The area
under the ROC curves were large (0.94 and 0.91, respec-
tively), indicating good performance for the diagnosis
of a urinary volume ≥600 mL. Moreover, a largest trans-
verse diameter of ≤9.7 cm excluded a bladder urinary
volume ≥600 mL with a high negative predictive value
of 98% (95% CI, 0.92–1.00) and 95% (95% CI, 0.74–0.99),
whereas measurements of >10 and 10.7 cm indicated a
bladder volume ≥600 mL with a positive predictive value
of 81% (95% CI, 0.62–0.94) and 87% (95% CI, 0.62–0.98),
values referring to Bladderscan or catheterized volume,
respectively. Nurses appeared to perform the procedure
efficiently after only a brief and standardized hands-on
training session with a good interobserver reliability,
therefore avoiding the recourse to complex 3-diameter
bladder evaluation.14
The performance of largest transverse diameter mea-
surement was compared with both the catheterized volume
and the Bladderscan because catheterized urine volume
would have not been available for all patients but mainly
for those with a large urinary volume according to the local
protocol. This could have lead to an overestimation of the
performance of the diameter measurement in predicting a
large bladder volume. This risk might be limited by combin-
ing the 2 areas of uncertainty, so we suggest using a clinical
gray zone ranging from 9.7 to 10.7 cm and considering mea-
surements between these thresholds inconclusive.
The findings are interesting from several perspectives.
First, the high negative predictive values suggest that

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 patients at risk of POUR with a largest transverse diam-

Lower and upper thresholds corresponding to the boundary of the “gray zone” of clinical uncertainty. Best threshold was determined using the Youden method. Note that the lower and best threshold is coincidentally
0.053 (0.008–0.4)
0.045 (0.007–0.3)
Table 2.  Detailed Performance of Various Thresholds of Bladder Largest Transverse Diameter in Predicting a Urinary Volume ≥600 mL as Measured

0.16 (0.07–0.4)
eter ≤9.7 cm could be discharged without catheterization,

likelihood ratio

0.48 (0.3–0.8)
Negative

(95% CI)
similar to the recommendations using an automatedscanner
when the volume is <600 mL (e.g., Bladderscan BVI 3000).2
Second, given the positive predictive value of this thresh-
old, it would appear reasonable to catheterize patients with
a bladder diameter >10.7 cm, therefore avoiding potential
POUR complications.1,3 Finally, the gray zone between these

6.72 (1.7–26.5)
12.5 (5.3–29.7)
6.47 (3.7–11.2)
likelihood ratio

2 cutoff points appears relatively slight, thus minimizing the

3.84 (1.9–7.7)
(95% CI)

number of inconclusive results. Given the relatively small

Positive

sample size, however, CIs are rather large and the number
of inconclusive results may have been underestimated, lead-
ing us to advise caution for boundary values. To our knowl-
edge, this is the first study assessing a simplified ultrasound
bladder measurement for the detection of POUR. In this
0.67 (0.48–0.82)
0.95 (0.74–0.99)
0.94 (0.87–0.98)
0.98 (0.92–1.00)
predictive value

study, a pocket-sized ultrasound apparatus equipped with

Negative

(95% CI)

a low-frequency transducer was used because of its porta-

bility. Images produced by this device are comparable with
those provided by conventional machines.15,16
Nevertheless, this study has several limitations. There is
no universally accepted definition of POUR with bladder
volumes ranging from 400 to 600 mL. In this study, a blad-
0.87 (0.62–0.98)
0.80 (0.61–0.92)
0.81 (0.62–0.94)
0.69 (0.52–0.84)
predictive value

der volume ≥600 mL was chosen because catheterization is

(95% CI)
Positive

performed at this volume as recommended in our local pro-

tocol.2,6 The automated ultrasound device (Bladderscan BVI
3000) was regarded as comparative because it provided a
noninvasive evaluation of the bladder volume for all patients,
whereas catheterization was only performed in 49 patients.
Indeed, good agreement between the Bladderscan estimates
0.92 (0.73–0.99)
0.75 (0.53–0.90)
0.93 (0.85–0.98)
0.85 (0.75–0.92)

of urinary bladder volume and urine volume measured after

Specificity
(95% CI)

emptying the bladder has been found in several studies.8,17,18

However, this measurement does not have the accuracy of a
“gold standard,” with a mean difference of −21.5 mL and lim-
its of agreement between −147 and +104 mL.8 Obtaining actual
bladder volumes by catheterization for all patients would have
provided more precise results to evaluate the accuracy of our
0.56 (0.35–0.76)
0.96 (0.79–0.99)
0.85 (0.65–0.95)
0.96 (0.80–0.99)

ultrasound measurements. This would, however, have neces-

Sensitivity
(95% CI)

sitated catheterizing all patients, which would be ethically

Using the Bladderscan BVI 3000 or After Catheterization

questionable when one considers the possible complications,

for example, urinary tract infection.19 We also did not include
patients who voided before discharge to the PACU. Indeed,
even if the voided volume could have been compared with
an ultrasound assessment of the urinary bladder, the residual
diameter
Bladder

>10.7
>9.7
>9.7

volume would have introduced a bias. Finally, a follow-up

(cm)

>10

procedure on patients after discharge to the PACU was not

performed. It may have obviated the need to catheterize some
of these patients.
the same, so they are presented on the same line.

In conclusion, our findings suggest that a simple ultrasound

Urinary volume after catheterization ≥600 mL

measurement of the largest transverse diameter using a stan-

dard ultrasound device provides valuable aid in the manage-
ment of patients at risk of POUR postoperatively. Those with
Bladderscan BVI 3000 ≥600 mL

a largest transverse diameter of ≤9.7 cm may be discharged

without voiding. Catheterization could be considered if this
measurement is >10.7 cm. The findings of this study directly
 Lower/best threshold
 Lower/best threshold

CI = confidence interval.

call into question the usefulness of expensive specific devices

for assessing POUR in the postoperative period. E
 Upper threshold
 Upper threshold

DISCLOSURES
Name: Aurélien Daurat, MD.
Contribution: This author helped design the study, conduct the
study, analyze the data, and write the manuscript.

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 Simplified Ultrasound Bladder Measurement
Attestation: Aurélien Daurat has seen the original study data,
reviewed the analysis of the data, approved the final manuscript,
and is the author responsible for archiving the study files.
Name: Olivier Choquet, MD.
Contribution: This author helped design the study and con-
duct the study.
Attestation: Olivier Choquet approved the final manuscript.
Name: Sophie Bringuier, PharmD, PhD.
Contribution: This author helped design the study, analyze the
data, and write the manuscript.
Attestation: Sophie Bringuier has seen the original study data,
reviewed the analysis of the data, and approved the final
manuscript.
Name: Jonathan Charbit, MD.
Contribution: This author helped design the study, analyze the
data, and write the manuscript.
Attestation: Jonathan Charbit approved the final manuscript.
Name: Michael Egan, MD.
Contribution: This author helped conduct the study and write
the manuscript.
Attestation: Michael Egan approved the final manuscript.
Name: Xavier Capdevila, MD, PhD.
Contribution: This author helped design the study, conduct the
study, analyze the data, and write the manuscript.
Attestation: Xavier Capdevila has seen the original study data
and approved the final manuscript.
This manuscript was handled by: Maxime Cannesson, MD, PhD.
ACKNOWLEDGMENTS
We thank all recovery room nurses for their participation in this
study.
REFERENCES
1. Tammela T, Kontturi M, Lukkarinen O. Postoperative urinary
retention. II. Micturition problems after the first catheterization.
Scand J Urol Nephrol 1986;20:257–60
2. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative uri-
nary retention: anesthetic and perioperative considerations.
Anesthesiology 2009;110:1139–57
3. Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M,
Keyes H. Factors affecting discharge time in adult outpatients.
Anesth Analg 1998;87:816–26
4. Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J,
Desmonts JM. Predictive factors of early postoperative uri-
nary retention in the postanesthesia care unit. Anesth Analg
2005;101:592–6
6   
www.anesthesia-analgesia.org
Copyright © 2015 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited.
5. Griesdale DE, Neufeld J, Dhillon D, Joo J, Sandhu S, Swinton
F, Choi PT. Risk factors for urinary retention after hip or knee
replacement: a cohort study. Can J Anesth 2011;58:1097–104
6. Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME.
Voiding in patients managed with or without ultrasound
monitoring of bladder volume after outpatient surgery. Anesth
Analg 1999;89:90–7
7. Hwang JY, Byun SS, Oh SJ, Kim HC. Novel algorithm for improv-
ing accuracy of ultrasound measurement of residual urine vol-
ume according to bladder shape. Urology 2004;64:887–91
8. Rosseland LA, Stubhaug A, Breivik H. Detecting postop-
erative urinary retention with an ultrasound scanner. Acta
Anaesthesiol Scand 2002;46:279–82
9. Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of
a biomarker. Anesthesiology 2010;112:1023–40
10. Balderi T, Mistraletti G, D’Angelo E, Carli F. Incidence of post-
operative urinary retention (POUR) after joint arthroplasty and
management using ultrasound-guided bladder catheterization.
Minerva Anestesiol 2011;77:1050–7
11. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32–5
12. Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ,
Vallet B, Tavernier B. Assessing the diagnostic accuracy of pulse
pressure variations for the prediction of fluid responsiveness: a
“gray zone” approach. Anesthesiology 2011;115:231–41
13. McGraw KO, Wong SP. Forming inferences about some intra-
class correlation coefficients. Psychol Methods 1996;1:30
14. Dudley NJ, Kirkland M, Lovett J, Watson AR. Clinical agree-
ment between automated and calculated ultrasound measure-
ments of bladder volume. Br J Radiol 2003;76:832–4
15. Frederiksen CA, Juhl-Olsen P, Larsen UT, Nielsen DG, Eika B,
Sloth E. New pocket echocardiography device is interchange-
able with high-end portable system when performed by expe-
rienced examiners. Acta Anaesthesiol Scand 2010;54:1217–23
16. Dijos M, Pucheux Y, Lafitte M, Réant P, Prevot A, Mignot A,
Barandon L, Roques X, Roudaut R, Pilois X, Lafitte S. Fast track
echo of abdominal aortic aneurysm using a real pocket-ultra-
sound device at bedside. Echocardiography 2012;29:285–90
17. Rosseland LA, Bentsen G, Hopp E, Refsum S, Breivik H.
Monitoring urinary bladder volume and detecting post-oper-
ative urinary retention in children with an ultrasound scanner.
Acta Anaesthesiol Scand 2005;49:1456–9
18. Moselhi M, Morgan M. Use of a portable bladder scanner to
reduce the incidence of bladder catheterisation prior to laparos-
copy. BJOG 2001;108:423–4
19. Stéphan F, Sax H, Wachsmuth M, Hoffmeyer P, Clergue F, Pittet
D. Reduction of urinary tract infection and antibiotic use after
surgery: a controlled, prospective, before-after intervention
study. Clin Infect Dis 2006;42:1544–51
anesthesia & analgesia