• Maximum voided volume is indicative of the maximal volumetric capacity of the bladder

• Average maximal voided volumes represent the functional capacity

• Daytime frequency of 3-4 hours is considered normal

• Degree of nocturia is usually dependent on the age of the patient

In adults, generally—

• Diurnal frequency is 5-7 voids

• Nocturnal frequency 0-1 void

• Normal voided volumes between 300 and 500 mL for women and 400 and 600 mL for men

• It is not unusual for the patients in their 50s and 60s to void once during the night and those in their 70s and 80s to have to get up 2 or 3 times nightly

Distinct patterns can be noted on FVC analysis:

• Normal volumes and normal frequency

• Normal volumes, but increased frequency: polyuria may be due to increased fluid intake, diabetes insipidus or mellitus

• Decreased volume: small volume voids both day and night might suggest detrusor overactivity (variable volumes) or bladder inflammation, sensory urgency or carcinoma in situ (fixed reduced volumes)

• Normal early morning void followed by decreased variable volumes for the rest of the day: usually due to a non-organic cause

• Increased nighttime frequency: nocturnal polyuria exists if >30% of total daily urine is passed at night time and may be idiopathic or secondary to congestive cardiac failure or renal failure

Bladder outflow obstruction (BOO):

• There are no typical FVC patterns that characterize BOO

• A range of features can be noted including small volume voids, frequency, nocturia, and urgency

Detrusor overactivity:

• A common finding is a pattern of frequent voids during the day and night with variable volumes

• Often episodes of marked urgency and urge incontinence depending on the symptom severity

• Important to exclude other possible causes of such irritative symptoms including an intravesical mass lesion or CIS (cys-toscopy is mandatory in patients over 40 years of age)

• An important feature is the fixed nature of the reduced void volumes (functional capacity) accompanying the frequency

Psychogenic pattern:

• Psychological difficulties often affect the bladder

• Patterns are difficult to predict

• Certain features, in the absence of any significant bladder pathology, are suggestive of a non-organic etiology for LUTS. These include—

■ Variable symptoms (worse during periods of stress and improve in between times)

■ Absent nocturia but marked daytime symptoms

■ Large first morning void, but small variable voids subsequently through the day

Patients who undergo bladder retraining must complete regular FVC in order to provide important biofeedback for the patient.

• FVC is a simple and non-invasive tool which is often underutilized

• Well accepted by patients

• A minimum of 3 days' data is required

• Limitations include

■ A minority fail to complete the diary due to a variety of reasons

■ Accuracy in record-keeping is important for pertinent data analysis

■ Symptoms may vary from period to period even within the same patient and it is important to avoid overinterpretation, but to use it as an adjunct to urody-namic assessment

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