Diagnostic Accuracy of Noninvasive Tests to Evaluate Bladder Outlet Obstruction in Men: Detrusor Wall Thickness, Uroflowmetry, Postvoid Residual Urine, and Prostate Volume

Oelke, Matthias; Höfner, K.; Jonas, Udo; Rosette, Jean J. de la; Ubbink, Dirk T.; Wijkstra, Hessel

doi:10.1016/j.eururo.2006.12.023

Cited by 219 publications

(169 citation statements)

References 22 publications

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“…Uroflowmetry was assessed in 2580 patients across 16 studies. Thirteen studies used a cutoff value of 10 ml/s to diagnose BOO and reported median sensitivity of 68.3%, specificity of 70.5%, a PPV of 74.3% and NPV of 68% [7,12,13,15,16,18,20,21,26,30,33,34,38,40,41]. However, studies varied considerably in their choice of defining variable and cutoff values.…”

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

“…DWT/BWT. DWT was studied in 848 patients across eight studies [6,8,16,17,24,31,33,34], five of which used a cutoff of 2 mm to define BOO, with high median sensitivity of 82.7%, specificity of 92.6%, a PPV of 90.5%, and NPV of 85%. Furthermore, a well-conducted exploratory study reported a cutoff value of 2.9 mm as having the best diagnostic value, with specificity of 100%.…”

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

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

et al. 2017

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Keywords:Bladder outlet obstruction (BOO) Men Lower urinary tract symptoms Diagnosis Urodynamics Noninvasive Systematic review Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: 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.

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Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

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

et al. 2017

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“…Afterwards, studies started to be published revealing the predictive value of DWT in men with BOO (7,9,10,12). In 2007, Kessler et al (12) found a significant correlation between DWT and pressure flow studies (PFS).…”

Section: Discussionmentioning

confidence: 99%

“…who was blinded to the IPSS results and LUTS severity of the men in the study groups, ultrasonography itself is a subjective assessment modality and is operator dependent. Currently, DWT measurement techniques have started to become standardized through numerous studies (4,5,7,9,10,19). It was previously demonstrated that DWT depends only on gender, bladder filling, and LUTS severity (7,18), and DWT was not affected by patient age (19).…”

Section: Discussionmentioning

confidence: 99%

“…Men who met the inclusion criteria were then asked to drink water until they felt the strong desire to void. Using real-time suprapubic transabdominal ultrasonography, the DWT was measured at the anterior bladder wall with the use of a 7.5-MHz linear ultrasound array (4,9). With the assistance of magnification, the adventitia, detrusor, and mucosa were identified.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Tokgöz

Tokgöz²,

Ünal³

et al. 2011

Diagn Interv Radiol

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Lower urinary tract symptoms (LUTS) are common, affecting approximately 40% of older men (1). LUTS is a recent term for what used to be known as prostatism (2). However, obstructive disorders of the lower urinary tract may also be caused by other diseases, such as bladder neck contractures, urethral valves, or external sphincter dyssynergia. However, for the majority of cases in the male population, the etiology is benign prostatic hyperplasia (BPH).Various animal and human studies have revealed that a significant enlargement of the bladder wall is attributable to smooth muscle cell hypertrophy, fibrocyte hyperplasia, and collagen deposition in the detrusor (3, 4). From a clinical perspective, thickening of the bladder wall should be considered as a sign of significant subvesical obstruction (5). The best way to visualize this detrusor muscle hypertrophy in a noninvasive manner is to measure the detrusor wall thickness (DWT) by suprapubic ultrasonography. In 2006, Belal and Abrams (6) evaluated noninvasive methods used to diagnose bladder outlet obstruction (BOO) in a meta-analysis and observed that ultrasound measurements of the DWT and bladder weight were the only predictors of subvesical obstruction in LUTS patients.It is widely accepted that DWT decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, the detrusor wall measurements are performed on patients when the bladder is filled to maximum capacity only (7). However, no study has been published that evaluates the diagnostic accuracy of DWT when the bladder is empty. In our study, we investigated the association between the LUTS severity and DWT. In addition, the parameter "DWT when the bladder was empty" was also evaluated as a noninvasive diagnostic tool to predict LUTS in men.An ideal assessment tool to detect LUTS must be noninvasive, quick, inexpensive, and reproducible with high diagnostic accuracy. Ultrasonography has all of these criteria with additional advantages (no contrast material and no ionizing radiation). In uro-radiology practice, conventional ultrasound-derived noninvasive tests for the evaluation of LUTS severity can achieve measurements of DWT, postvoid residual urine volume (PVR), and prostate and bladder volumes. Hence, our primary aim in this prospective, controlled clinical study was to analyze the diagnostic accuracy of these ultrasound-derived noninvasive tools (i.e., DWT when the bladder is full and empty, PVR, and bladder and prostate volumes) in healthy, mildly symptomatic, and moderately-toseverely symptomatic men, and compare the outcomes in each group. In addition, their correlation according to International Prostate Symptom Score (IPSS) and age groups as well as differences in DWT values were also investigated. Our hypothesis was that these tests would accurately discriminate symptomatic cases from healthy subjects and would ABDOMINAL IMAGING MATERIALS AND METHODSDuring an 18-month period, a total of 243 males were included in the study. Three groups were a...

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Does This Man With Lower Urinary Tract Symptoms Have Bladder Outlet Obstruction?

D’Silva

Dahm

Wong

2014

JAMA

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Diagnostic Accuracy of Noninvasive Tests to Evaluate Bladder Outlet Obstruction in Men: Detrusor Wall Thickness, Uroflowmetry, Postvoid Residual Urine, and Prostate Volume

Cited by 219 publications

References 22 publications

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

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

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Does This Man With Lower Urinary Tract Symptoms Have Bladder Outlet Obstruction?

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