Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Autor: Alexander Bachmann, Stavros Gravas, Christian Gratzke, Arjun Nambiar, Roland Umbach, Thomas B. Lam, Thorsten Bach, Mauro Gacci, Kari A.O. Tikkinen, Stephan Madersbacher, Sachin Malde, Charalampos Mamoulakis, Marcus J. Drake
Přispěvatelé: Clinicum, Urologian yksikkö, Department of Surgery, Department of Public Health, HUS Abdominal Center
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
NEAR-INFRARED SPECTROSCOPY
Urology
Urinary Bladder
030232 urology & nephrology
MEDLINE
Context (language use)
Noninvasive
Sensitivity and Specificity
PARAMETERS
03 medical and health sciences
Bladder outlet obstruction
0302 clinical medicine
DOPPLER ULTRASONOGRAPHY
Lower Urinary Tract Symptoms
Lower urinary tract symptoms
Diagnosis
medicine
WALL THICKNESS
Pressure
Humans
PRESSURE-FLOW
ULTRASOUND
INTRAVESICAL PROSTATIC PROTRUSION
PENILE CUFF TEST
Ultrasonography
Spectroscopy
Near-Infrared
business.industry
Clinical study design
Prostate
Men
Ultrasonography
Doppler
Gold standard (test)
medicine.disease
3126 Surgery
anesthesiology
intensive care
radiology
3. Good health
Surgery
Clinical trial
Urinary Bladder Neck Obstruction
Urodynamics
Systematic review
030220 oncology & carcinogenesis
Bladder outlet obstruction (BOO)
COMPRESSION-RELEASE MANEUVER
Radiology
business
Zdroj: European urology. 71(3)
ISSN: 1873-7560
Popis: Context: Several noninvasive tests have been developed for diagnosing bladder outlet obstruction (BOO) in men to avoid the burden and morbidity associated with invasive urodynamics. The diagnostic accuracy of these tests, however, remains uncertain. Objective: To systematically review available evidence regarding the diagnostic accuracy of noninvasive tests in diagnosing BOO in men with lower urinary tract symptoms (LUTS) using a pressure-flow study as the reference standard. Evidence acquisition: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central, Google Scholar, and WHO International Clinical Trials Registry Platform Search Portal databases were searched up to May 18, 2016. All studies reporting diagnostic accuracy for noninvasive tests for BOO or detrusor underactivity in men with LUTS compared to pressure-flow studies were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the QUADAS-2 tool. Evidence synthesis: The search yielded 2774 potentially relevant reports. After screening titles and abstracts, 53 reports were retrieved for full-text screening, of which 42 (recruiting a total of 4444 patients) were eligible. Overall, the results were predominantly based on findings from nonrandomised experimental studies and, within the limits of such study designs, the quality of evidence was typically moderate across the literature. Differences in noninvasive test threshold values and variations in the urodynamic definition of BOO between studies limited the comparability of the data. Detrusor wall thickness (median sensitivity 82%, specificity 92%), near- infrared spectroscopy (median sensitivity 85%, specificity 87%), and the penile cuff test (median sensitivity 88%, specificity 75%) were all found to have high sensitivity and specificity in diagnosing BOO. Uroflowmetry with a maximum flow rate of 10 mm was reported to have similar diagnostic accuracy, with median sensitivity of 68% and specificity of 75%. Conclusions: According to the literature, a number of noninvasive tests have high sensitivity and specificity in diagnosing BOO in men. However, although the majority of studies have a low overall risk of bias, the available evidence is limited by heterogeneity. While several tests have shown promising results regarding noninvasive assessment of BOO, invasive urodynamics remain the gold standard. Patient summary: Urodynamics is an accurate but potentially uncomfortable test for patients in diagnosing bladder problems such as obstruction. We performed a thorough and comprehensive review of the literature to determine if there were less uncomfortable but equally effective alternatives to urodynamics for diagnosing bladder problems. We found that some simple tests appear to be promising, although they are not as accurate. Further research is needed before these tests are routinely used in place of urodynamics. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Databáze: OpenAIRE
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