Diagnosis Of Bladder Outlet Obstruction Research Articles

Clinical value of neutrophil to lymphocyte ratio and ultrasonic parameters in the diagnosis of bladder outlet obstruction in benign prostatic hyperplasia

AimThis study aimed to investigate the clinical significance of neutrophil-to-lymphocyte ratio and ultrasonic parameters in diagnosing bladder outlet obstruction in patients with benign prostatic hyperplasia. MaterialBetween September 2022 and January 2024, a total of 106 patients with benign prostatic hyperplasia were collected from Hongqi Hospital affiliated to Mudanjiang Medical University followed by urodynamic testing. The patients were categorized into three groups based on the International Prostate Symptom Score: mild (45 cases), moderate (36 cases), and severe (25 cases). Thirty-five healthy men were recruited at the hospital as a control group. All patients had blood tests and ultrasound scans. ResultsNeutrophil-to-lymphocyte ratio, detrusor wall thickness, detrusor muscle elastic modulus, internal gland elastic modulus, intravesical prostatic protrusion, and post-voiding residual volume were significantly correlated with the bladder outlet obstruction stage and showed good diagnostic efficiency (all P<0.05. There was no statistically significant difference observed in the external gland elastic modulus between the experimental group and the control group (P>0.05). ConclusionsThe neutrophil-to-lymphocyte ratio, detrusor wall thickness, elastic modulus of the detrusor and glandular gland may hold clinical significance for diagnosing bladder outlet obstruction resulting from benign prostatic hyperplasia. Level of evidence3.

A novel predictive model for noninvasively diagnosing bladder outlet obstruction in female patients based on clinical features and uroflowmetry parameters.

To develop and validate a simple prediction model to diagnose female bladder outlet obstruction (fBOO) because of the invasive nature of standard urodynamic studies (UDS) for diagnosing fBOO. We retrospectively analyzed the data of 728 women who underwent UDS at Tongji Hospital between 2011 and 2021. The definition of fBOO was Pdet.Qmax - 2.2 × Qmax > 5 (BOOIf > 5). Independent predictive factors of fBOO were determined by multivariable logistic regression analysis. These predictive factors were incorporated into a predictive model to assess the risk of fBOO. Of the 728 patients, 249 (34.2%) were identified as having fBOO and these women were randomly assigned to two groups, a model development group and a model validation group. Multivariate logistic regression demonstrated that age, Qmax , flow time, and voiding efficiency were independent risk factors for fBOO. The predictive model of fBOO showed a satisfactory performance, with area under the curve being 0.811 (95% confidence interval [CI] 0.771-0.850, P < 0.001), which was confirmed to be 0.820 (95% CI 0.759-0.882, P < 0.001) with external validation. The calibration curve indicated that the predicted probability had an excellent correspondence to observed frequency. Decision curve analysis demonstrated a greater clinical net benefit compared with the strategies of treat all or treat none when the predicted risk was in a range of 3% and 75%. A novel predictive model of fBOO was developed and validated based on clinical features and noninvasive test parameters in female patients with lower urinary tract symptoms. The model is a quick and easy-to-use tool to assess the risk of fBOO for urologists in their routine practice without an invasive UDS.

Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors

Study ObjectiveTo determine the outcome of voiding function 1 year following Pelvic Reconstructive Surgery (PRS) in women with Bladder Outlet Obstruction (BOO). DesignRetrospective cohort study SettingTertiary Referral Hospital PatientsOne thousand eight hundred and ninety-four (1894) women underwent PRS for advanced Pelvic Organ Prolapse (POP) stage III-IV with urodynamic findings of BOO InterventionsPelvic Reconstructive Surgery MeasurementsThe primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic (UDS) testing at one year post-operatively. The secondary outcomes are to identify the different risk factors for persistence voiding dysfunction after 1 year after PRS. Main ResultsTotal of 431 women with POP-Q Stage III and IV, UDS of Qmax ≤15 ml/s and PdetQmax ≥20cmH20 were included. Resumption of normal voiding function were found in 91% (n=392/431), while 9% (n=39/431) remains to have voiding dysfunction (VD) 1 year post operatively. Those with persistent VD, 20.5%(n=8/39) remains having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression reveals factors associated with post-operative VD are pre-operative MCC ≥500 ml and PVR ≥ 200ml. ConclusionVoiding Dysfunction may persist in women with BOO following PRS, particularly in those with pre-operative maximal cystometric capacity (MCC) of >500ml and post-void residual volume > 200ml.

Interobserver agreement in the diagnosis of bladder outlet obstruction in women

The diagnosis of bladder outlet obstruction (BOO) in women is a challenge for functional urology. In Mexico there are few data that report the prevalence of OTSV in women, being up to 24% in a group of patients. The aim of this study is to compare six different definitions of bladder outlet obstruction and evaluate the interobserver agreement in an educational setting. Urodynamic studies (UDS) of women with and without diagnosis of BOO were retrospectively assesed. Farrar, Chassagne, Lemack, Defreitas, Blavais and Groutz, Solomon-Greenwell definitions were evaluated. All UDS were independently reviewed by 5 observers. The easiest, the hardest and the fastest were chosen. Interobserver agreement to classify the patients as obstructed was assessed by kappa reliability statistical analysis. We classified the type of mistakes the participants made; error of interpretation and miscalculation. A total of 28 urodynamic studies were reviewed. All observers had a substantial agreement (0.64-0.78) to classify BOO using all but Lemack and Solomon-Greenwell definitions. A total 120 errors from 840 responses were found; 45.8% errors of interpretation of UDS and 54.1% miscalculation of the equation. Finally, all the participants chose the Solomon-Greenwell was the most difficult definition. Chassagne, Defreitas and Farrar definitions proved substantial interobserver agreement. Solomon-Greenwell and Lemack´s definitions had the highest number of pitfalls and the lowest level of agreement.

Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement.

Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

MP74-17 PENILE CUFF TEST SHOWS POOR ACCURACY FOR DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION FOR MEN: A PRAGMATIC ANALYSIS WITHIN A HIGH VOLUME UROLOGIC CLINIC

You have accessJournal of UrologyCME1 Apr 2023MP74-17 PENILE CUFF TEST SHOWS POOR ACCURACY FOR DIAGNOSIS OF BLADDER OUTLET OBSTRUCTION FOR MEN: A PRAGMATIC ANALYSIS WITHIN A HIGH VOLUME UROLOGIC CLINIC Leo D. Dreyfuss, Maria Lee, Joseph Moryousef, Christina Sze, Lina Posada-Calderon, Dean Elterman, Naeem Bhojani, Kevin C. Zorn, Bilal Chughtai, Steven A. Kaplan, and Alexis E. Te Leo D. DreyfussLeo D. Dreyfuss More articles by this author , Maria LeeMaria Lee More articles by this author , Joseph MoryousefJoseph Moryousef More articles by this author , Christina SzeChristina Sze More articles by this author , Lina Posada-CalderonLina Posada-Calderon More articles by this author , Dean EltermanDean Elterman More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Kevin C. ZornKevin C. Zorn More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Steven A. KaplanSteven A. Kaplan More articles by this author , and Alexis E. TeAlexis E. Te More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been a recent shift in the management offerings for treatment of benign prostatic hyperplasia (BPH). Patients desire minimally invasive therapies with lower risks of complications, side effects and discomfort. Penile cuff test (PCT) is a non-invasive bladder pressure manometer use to measure detrusor pressure and urine flow. Recently, PCT has demonstrated noninferiority compared to the gold standard pressure flow studies (PFS), which require placement of catheters within urethra and rectum. We sought to compare the accuracy of PCT to PFS in the real world setting of a high volume academic voiding dysfunction clinic. METHODS: Adult men with BPH underwent PCT and PFS from April 2018-October 2021. PFS and PCT were obtained by trained technologists. All patients participated in urodynamic evaluation which included measurement of vesicular and abdominal pressures at time of filling and voiding as well as post-void residual. The diagnosis of bladder outlet obstruction was determined by ICS and PCT nomogram for UDS and PCT, respectively. RESULTS: 74 male patients were included. The PCT nomogram classified 21 patients as obstructed and 53 as un-obstructed. Out of the 53 individuals classified as unobstructed by PCT, 29 were identified as non-obstructive/equivocal on UDS and 24 were identified as unobstructed on UDS. With UDS as gold standard, PCT showed a sensitivity of 0.31 and specificity of 0.75. The positive predictive value (PPV) was 0.62 and negative predictive value (NPV) was 0.45. Detrusor pressure at Qmax for UDS and cuff pressure at interruption during PCT was correlated with AUA symptoms score (AUA SS) (p<0.05, Table 2). CONCLUSIONS: Our single-center experience with penile cuff testing demonstrates poor accuracy in diagnosis of bladder outlet obstruction when compared to pressure flow studies, in contrast to recent meta-analysis comparing similar modalities. PCT is associated with AUA SS, demonstrating possible clinical utility. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1077 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D. Dreyfuss More articles by this author Maria Lee More articles by this author Joseph Moryousef More articles by this author Christina Sze More articles by this author Lina Posada-Calderon More articles by this author Dean Elterman More articles by this author Naeem Bhojani More articles by this author Kevin C. Zorn More articles by this author Bilal Chughtai More articles by this author Steven A. Kaplan More articles by this author Alexis E. Te More articles by this author Expand All Advertisement PDF downloadLoading ...

Solomon-Greenwell as the most accurate nomogram for female bladder outlet obstruction

Objective: Compare the different definitions for bladder outlet obstruction (BOO) in women with dysfunctional voiding (DV) and find which one is most specific and sensitive to achieve a more accurate diagnosis. Materials and methods: a cross-sectional study of urodynamic investigation studies from women diagnosed with DV in a period from 2017-2020 were classified with obstruction or not, based on 6 urodynamic definitions. The control group were women who had been categorized with obstruction in at least 3 definitions of BOO. Likelihood positive ratio, sensitivity and specificity were calculated. Statistical analysis was carried out by IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, N.Y., USA). A p &lt;0.5 was considered statistically significant. Results: A total of 146 urodynamic studies were analyzed, Solomon-Greenwell nomogram has shown to be the more specific and sensitive, obtaining the highest likelihood positive ratio &gt;100. The comparison between our the control group and every definition of BOO has shown statistically significant difference. Conclusions: The diagnosis of BOO requires expertise and individualization, it is made through physical examination and complete urodynamic study, Solomon-Greenwell has shown to be specific and sensitive for diagnosis in the group of study.

Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO).

Diagnosis of bladder outlet obstruction (BOO) in females is often challenging, not only because of the overlap in storage and voiding symptoms in women with various etiologies of lower urinary tract (LUT) dysfunction but also due to the lack of standardized urodynamic criteria to define the condition. There is an unmet need of biologic markers to evaluate BOO in females as an adjunct to other clinical criteria. We sought to elucidate the role of urinary biomarkers in female BOO. We performed a systematic review of studies involving urinary biomarkers in female BOO. The search was performed in PubMed. A total of 58 papers were retrieved and 2 were included for final analysis. Currently, there are no validated biologic markers for female BOO available. Having a biomarker that can be obtained through a urine sample will be an invaluable tool to evaluate and counsel patients with LUT symptoms and possible BOO. The use of NGF as an indicator of BOO in female patients seems to be promising: NGF levels are elevated in women with BOO when compared with normal controls. We found that NGF levels may be applied as a useful biomarker in the diagnosis and evaluation of female patients with BOO symptoms. It will not completely replace other clinical diagnostic tools such as formal urodynamic testing but play a role as a supplement to it. Nevertheless, further studies should be conducted to establish NGF levels as a female BOO biomarker and a routine testing modality.

The diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction in men with lower urinary tract symptoms: A meta-analysis.

We conducted the first meta-analysis to determine the diagnostic value of non-invasive methods for diagnosing bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). We searched a range of databases for relevant publications up to June 2022, including PubMed, Embase, Web of Science, and the Cochrane Library. Retrieved studies were then reviewed for eligibility and data were extracted. The risk of bias (RoB) was assessed using the QUADAS-2 tool. We then performed a formal meta-analysis to evaluate the accuracy of various non-invasive methods for diagnosing BOO in men. We identified 51 eligible studies including 7,897 patients for meta-analysis. The majority of the studies had a low overall RoB. Detrusor wall thickness (DWT) (pooled sensitivity (SSY): 71%; specificity (SPY): 88%; diagnostic odds ratio (DOR): 17.15; area under curve (AUC) 0.87) and the penile cuff test (PCT) (pooled SSY: 87%; SPY: 78%; DOR: 23.54; AUC: 0.88) showed high accuracy for diagnosing BOO. Furthermore, data suggested that DWT had the highest pooled SPY (0.89), DOR (32.58), and AUC (0.90), when using 2 mm as the cut-off. Of the non-invasive tests tested, DWT and PCT had the highest levels of diagnostic accuracy for diagnosing BOO in men with LUTS. DWT, with a 2 mm cut-off, had the highest level of accuracy. These two methods represent good options as non-invasive tools for evaluating BOO in males.

Is Bladder Outlet Obstruction Diagnosis with Uroflow Parameters Without Urodynamics?

Is Bladder Outlet Obstruction Diagnosis with Uroflow Parameters Without Urodynamics?

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction.

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery. A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson's disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction. The mean age was 71.1 ± 9.8years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms. Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.

Use of the penile cuff test to diagnose bladder outlet obstruction: A systematic review and meta-analysis.

Among noninvasive modalities for assessing bladder outlet obstruction (BOO), the penile cuff test (PCT) is the most used in clinical practice. The purpose of this review was to evaluate the performance of PCT in diagnosing and managing BOO. PubMed, Scopus, CINAHL, Embase, Cochrane Library, and Web of Science were searched for studies investigating use of PCT for BOO. Studies evaluating diagnostic parameters, inter-observer agreements, or treatment outcomes using PCT were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed (PROSPERO ID: CRD42022300047). A proportional meta-analysis was done for diagnostic accuracy proportions. The Egger's and the Begg-Mazumdar rank-correlation tests were used to assess publication bias. Risk of bias was assessed using the Gradings of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Of the 272 articles retrieved, 17 were included in qualitative synthesis and meta-analysis was performed on five studies (comprising 448 patients). Two studies evaluating inter-observer agreement demonstrated 95% agreement and five studies evaluating procedures reported a 66%-80% surgical success rate on obstructed patients using PCT. From the proportional meta-analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.85 (95% CI 0.71-0.95) 0.78 (95% CI 0.67-0.87), 0.74 (95% CI 0.52-0.91), and 0.87 (95% CI 0.73-0.96), respectively. Publication bias was noted for PPV but not for sensitivity, specificity, or NPV. Based on the GRADE criteria, there were two low, six moderate, and nine high-quality studies. PCT performs sufficiently in diagnosing and managing BOO. However, due to variability in obstruction criteria assessment, more studies comparing diagnostic criteria are warranted.

Urodynamic Curve Patterns may Predict Female Bladder Outlet Obstruction and Detrusor Underactivity

To search for independent predictors for distinguishing bladder outlet obstruction (BOO) and detrusor underactivity (DU) in female patients with voiding difficulty. A retrospective patient file review was performed of 918 female patients with lower urinary tract symptoms. After exclusion criteria, 148 patients with voiding difficulty were eligible for the study. Patients were classified as having BOO and DU based on urodynamic BOO and DU definitions. The symptoms, patient characteristics, the patterns of free urine flow, and detrusor voiding pressure curves were compared between 2 groups. Of 148 patients with a median age of 53 (18-86), 42 (28,4%), 37 (25%), 69 (46,6%) patients had a urodynamic diagnosis of BOO, DU, and unclassified P/F study respectively. Multivariate logistic regression analysis results showed that the symptom of weak urine stream [P=.015 OR=7.07 CI(1,47-34,0)], the negative provocative stress test [P=.038 OR=7.32 CI(1,12-47,83)], the continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns [P < .001 OR=2,99 CI(1,66-5,38)] were the independent predictors of BOO. Sensitivity and specifity values for prolonged/tailed to predict BOO were 82.5 and 60% respectively. The continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns were found to be useful independent predictors for distinguishing BOO from DU in female patients with voiding difficulty. In addition, the symptom of weak urine stream, and the negative provocative stress test may be of beneficial use.

The influence of intubation on urinary flow parameters in pressure-flow study and its significance for urodynamic diagnosis.

Transurethral catheterization in pressure-flow study (PFS) may interfere with the function of the lower urinary tract and produce an incorrect urodynamic diagnosis. We aimed to investigate the influence of a 7F catheter on urinary flow parameters in PFS and its significance for urodynamic diagnosis. Our hypothesis was that intubation causes adverse effects on urinary flow rate and further influences the urodynamic diagnosis. We reviewed a urodynamic database of men and women referred for evaluation of lower urinary tract symptoms. The urinary flow parameters of PFS and free flow (FF) were compared. The influence of intubation on urodynamic diagnosis was determined by re-evaluating bladder outlet obstruction (BOO) and detrusor underactivity (DU), with the maximum flow rate of PFS (Qmax.P) being replaced by Qmax of FF (Qmax.F). We initially screened 1,791 patients and included 1,144 for the analysis. Overall, PFS had a lower Qmax (p< 0.001), longer flow time (p < 0.001), and a similar voided volume (p> 0.05). However, Qmax.P displayed inconsistent changing directions: Qmax.P decreased in 72.8% of male patients and 83.5% of female patients but increased in 14.7% of male patients and 9.5% female patients. Qmax.P was unchanged in the remaining patients. The urodynamic diagnosis of BOO and DU changed correspondingly in both the decreased group and the increased group when Qmax.P was replaced by Qmax.F. Compared with Qmax.F, the changing directions and magnitude of Qmax.P varied with each individual, which could have a significant impact on urodynamic diagnosis. Thus, when a similar volume is voided in FF and PFS, and Qmax.P differs obviously from Qmax.F, replacing Qmax.P with Qmax.F for evaluating BOO and DU may be a sensible choice.

Urgency and urgency incontinence following stress urinary incontinence surgery: A review of evaluation and management.

The presence of urgency urinary incontinence (U/UUI) after sling surgery is a common reason for dissatisfaction and imposition on quality of life. We aimed to evaluate and analyze the pathophysiology, evaluation, and treatment of U/UUI after sling surgery. A MEDLINE review was performed for relevant, English-language articles relating to storage and emptying symptoms after sling surgery. U/UUI may persist, be improved, or worsen in women with preoperative mixed urinary incontinence and may appear de novo in those women originally presenting with pure stress urinary incontinence (SUI). While the exact mechanism is not clear, partial bladder outlet obstruction (BOO) should always be suspected, especially in those women with worsened or de novo symptoms soon after sling surgery. Initial workup should elucidate the temporality, quality, and bother associated with symptoms and to evaluate the woman for urinary tract infection (UTI), pelvic organ prolapse (POP), or perforation of the lower urinary tract. The utility of urodynamics in attaining a definitive diagnosis of BOO is inconclusive. Treatment options include reevaluation of the patient after sling incision or after addressing UTI, POP, and perforation of the bladder or urethra. Women also typically undergo a multitiered approach to storage lower urinary tract symptoms outlined in the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Overactive Bladder Guidelines. While improvement is typically seen with multimodality treatment, all women should be counseled regarding need for additional treatment for U/UUI, BOO, and SUI in the future.

Bladder Sonomorphological Tests in Diagnosing Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis

Aims: We aimed to investigate the accuracy of bladder sonomorphological parameters including detrusor wall thickness (DWT) and ultrasound-estimated bladder weight (UEBW) for diagnosing bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS). Methods: A comprehensive search was conducted through databases including PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, China Knowledge Network (CNKI), China Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP) to select studies assessing the diagnostic accuracy of DWT and UEBW to diagnose BOO in adults with LUTS. Databases were searched from inception to 2020 without restriction. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy were calculated using random-effects model. Results: The initial search included 84 publications, of which 78 publications were screened, and 16 studies with 1,847 patients finally contained diagnostic data. The results from 10 out of 16 studies assessing DWT showed a pooled sensitivity (SSY) of 0.68 (95% CI, 0.56–0.78) and specificity (SPY) of 0.91 (95% CI, 0.82–0.96) with I² values of 93%, while 6 studies evaluating UEBW were analyzed with a SSY of 0.88 (95% CI, 0.78–0.93) and SPY of 0.81 (95% CI, 0.67–0.90) with I² values of 83%. Conclusions: DWT shows high SPY, and UEBW performs high SSY of diagnosing BOO. Further well-designed studies are needed to evaluate the utilization of DWT and UEBW for the diagnosis of BOO.

Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate

PurposeTo assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients.MethodsRetrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16.Results233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75–136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03–3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48–3.02, p = 0.035) were the independent predictors of BOO.ConclusionRT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.

MP22-02 THE ROLE OF ULTRASOUND ESTIMATED DETRUSOR WALL THICKNESS IN THE PREDICTION OF BLADDER OUTLET OBSTRUCTION IN MALES

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-02 THE ROLE OF ULTRASOUND ESTIMATED DETRUSOR WALL THICKNESS IN THE PREDICTION OF BLADDER OUTLET OBSTRUCTION IN MALES Harmanmeet Singh, J. V. S. Prakash, S. Vetrichandar, K. V. Arasi, V. Natarjan, and Arun Kumar Paranjothi Harmanmeet SinghHarmanmeet Singh More articles by this author , J. V. S. PrakashJ. V. S. Prakash More articles by this author , S. VetrichandarS. Vetrichandar More articles by this author , K. V. ArasiK. V. Arasi More articles by this author , V. NatarjanV. Natarjan More articles by this author , and Arun Kumar ParanjothiArun Kumar Paranjothi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder Outlet Obstruction (BOO) is one of the common cause for Lower Urinary Tract Symptoms(LUTS) in men. Pressure-flow urodynamics is the investigation of choice in the diagnosis of BOO. In our routine practice, especially in developing countries we depend on lesser invasive methods including uroflowmetry, prostate volume, and Post void residual urine (PVR). There are many non-invasive methods for diagnosing BOO, one among them is measuring Detrusor Wall Thickness (DWT) using ultrasonography. The objective of our study is to compare the accuracy of Detrusor Wall Thickness (DWT) to other non invasive tests and Pressure Flow Study (as a reference) in the assessment of BOO in men presenting with LUTS. METHODS: This prospective study included 86 patients who were neurologically free with Bladder outlet obstruction. Men over 50 years were studied for BOO using detrusor wall thickness along with tests such as uroflowmetry, prostate volume and Post-Void Residual (PVR) which was then compared to pressure flow study as the gold standard. All patients were submitted to a history, clinical examination, urine analysis and culture and blood chemistry. RESULTS: The DWT was ranging from 0.6 mm to 8.2 mm. Among the 86 patients studied 36 were diagnosed as BOO with DWT≥2 mm. Based on the pressure-flow test, 40 patients had BOO. Detrusor wall thickness had the highest specificity (95.6%), positive predictive value (94.7%) and accuracy (93.02%) as a non-invasive test in diagnosing BOO. CONCLUSIONS: Detrusor wall thickness has a better specificity, accuracy and positive predictive value compared to other tests. Measuring DWT as an additional parameter along with other non-invasive tests can greatly increase the accuracy of diagnosing BOO. Further studies are required to validate the findings of this study before this technique can be recommended as a primary diagnostic tool for BOO. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e390-e391 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harmanmeet Singh More articles by this author J. V. S. Prakash More articles by this author S. Vetrichandar More articles by this author K. V. Arasi More articles by this author V. Natarjan More articles by this author Arun Kumar Paranjothi More articles by this author Expand All Advertisement Loading ...

Development of an artificial intelligence diagnostic system for lower urinary tract dysfunction in men.

To establish an artificial intelligence diagnostic system for lower urinary tract function in men with lower urinary tract symptoms using only uroflowmetry data and to evaluate its usefulness. Uroflowmetry data of 256 treatment-naive men with detrusor underactivity, bladder outlet obstruction, or detrusor underactivity+bladder outlet obstruction were used for artificial intelligence learning and validation using neural networks. An optimal artificial intelligence diagnostic model was established using 10-fold stratified cross-validation and data augmentation. Correlations of bladder contractility index and bladder outlet obstruction index values for the artificial intelligence system and pressure flow study values were examined using Spearman's correlation coefficients. Additionally, diagnostic accuracy was compared between the established artificial intelligence system and trained urologists with uroflowmetry data of 25 additional patients by χ2 -tests. Detrusor underactivity was defined as bladder contractility index ≤100 and bladder outlet obstruction index ≤40, bladder outlet obstruction was defined as bladder contractility index >100 and bladder outlet obstruction index >40, and detrusor underactivity+bladder outlet obstruction was defined as bladder contractility index ≤100 and bladder outlet obstruction index >40. The artificial intelligence system's estimated bladder contractility index and bladder outlet obstruction index values showed significant positive correlations with pressure flow study values (bladder contractility index: r=0.60, P<0.001; bladder outlet obstruction index: r=0.46, P<0.001). The artificial intelligence system's detrusor underactivity diagnosis had a sensitivity and specificity of 79.7% and 88.7%, respectively, and those for bladder outlet obstruction diagnosis were 76.8% and 84.7%, respectively. The artificial intelligence system's average diagnostic accuracy was 84%, which was significantly higher than that of urologists (56%). Our artificial intelligence diagnostic system developed using the uroflowmetry waveform distinguished between detrusor underactivity and bladder outlet obstruction with high sensitivity and specificity in men with lower urinary tract symptoms.

Urinary miRNA profiles discriminate between obstruction-induced bladder dysfunction and healthy controls

Urgency, frequency and incomplete emptying are the troublesome symptoms often shared between benign prostatic obstruction-induced (BLUTD) and neurogenic (NLUTD) lower urinary tract dysfunction. Previously, using bladder biopsies, we suggested a panel of miRNA biomarkers for different functional phenotypes of the bladder. Urine is a good source of circulating miRNAs, but sex- and age-matched controls are important for urinary metabolite comparison. In two groups of healthy subjects (average age 32 and 57 years old, respectively) the total protein and RNA content was very similar between age groups, but the number of secreted extracellular vesicles (uEVs) and expression of several miRNAs were higher in the young healthy male volunteers. Timing of urine collection was not important for these parameters. We also evaluated the suitability of urinary miRNAs for non-invasive diagnosis of bladder outlet obstruction (BOO). A three urinary miRNA signature (miR-10a-5p, miR-301b-3p and miR-363-3p) could discriminate between controls and patients with LUTD (BLUTD and NLUTD). This panel of representative miRNAs can be further explored to develop a non-invasive diagnostic test for BOO. The age-related discrepancy in the urinary miRNA content observed in this study points to the importance of selecting appropriate, age-matched controls.