Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Karl H.  Pang; Riccardo Campi; Salvador Arlandis; Kari Bø; Christoper R.  Chapple; Elisabetta  Costantini; Fawzy Farag; Jan  Groen; Markos Karavitakis; Marie Carmela M. Lapitan; Margarida  Manso; Serenella  Monagas Arteaga; Arjun K. Nambiar; Aisling  Nic An Ríogh; Eabhann  O'Connor; Nadir I.  Osman; Benoit Peyronnet; Véronique  Phé; Vasileios I.  Sakalis; Néha  Sihra; Lazaros  Tzelves; Huub  van der vaart; Yuhong  Yuan; Muhammad Imran Omar; Christopher K.  Harding

doi:10.1016/j.euf.2021.09.003

Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Karl H. Pang, Riccardo Campi, Salvador Arlandis, Kari Bø, Christoper R. Chapple, Elisabetta Costantini, Fawzy Farag, Jan Groen, Markos Karavitakis, Marie Carmela M. Lapitan, Margarida Manso, Serenella Monagas Arteaga, Arjun K. Nambiar, Aisling Nic An Ríogh, Eabhann O'Connor, Nadir I. Osman, Benoit Peyronnet, Véronique Phé, Vasileios I. Sakalis, Néha SihraLazaros Tzelves, Huub van der vaart, Yuhong Yuan, Muhammad Imran Omar^* (Corresponding Author), Christopher K. Harding

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

9 Citations (Scopus)

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Abstract

Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain.Objective: To identify and compare different tests to diagnose fBOO through a systematic review process.Evidence Acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4th 2020. Studies on women >18 years with suspected BOO involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles and performed data extraction. The risk of bias was assessed using QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/- fluoroscopy were evaluated in 25 studies. Transperineal doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6- 92.5%, 64.6-93.9%, and 64.1-92.2% respectively.Conclusion: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies +/- fluoroscopy remains the current standard for diagnosing fBOO.Patient Summary: Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies +/- fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women.

Original language	English
Pages (from-to)	1015-1030
Number of pages	16
Journal	European Urology Focus
Volume	8
Issue number	4
Early online date	17 Sept 2021
DOIs	https://doi.org/10.1016/j.euf.2021.09.003
Publication status	Published - 1 Jul 2022

Bibliographical note

Acknowledgements
Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.

Data Availability Statement

Supplementary data
Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.
1016/j.euf.2021.09.003.

Keywords

Accuracy
Bladder outlet obstruction
Diagnosis
Female
Lower urinary tract symptoms
Test
Urodynamics

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Pang, K. H., Campi, R., Arlandis, S., Bø, K., Chapple, C. R., Costantini, E., Farag, F., Groen, J., Karavitakis, M., Lapitan, M. C. M., Manso, M., Monagas Arteaga, S., Nambiar, A. K., Nic An Ríogh, A., O'Connor, E., Osman, N. I., Peyronnet, B., Phé, V., Sakalis, V. I., ... Harding, C. K. (2022). Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel . European Urology Focus, 8(4), 1015-1030. https://doi.org/10.1016/j.euf.2021.09.003

Pang, KH, Campi, R, Arlandis, S, Bø, K, Chapple, CR, Costantini, E, Farag, F, Groen, J, Karavitakis, M, Lapitan, MCM, Manso, M, Monagas Arteaga, S, Nambiar, AK, Nic An Ríogh, A, O'Connor, E, Osman, NI, Peyronnet, B, Phé, V, Sakalis, VI, Sihra, N, Tzelves, L, van der vaart, H, Yuan, Y, Omar, MI & Harding, CK 2022, 'Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel ', European Urology Focus, vol. 8, no. 4, pp. 1015-1030. https://doi.org/10.1016/j.euf.2021.09.003

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title = "Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel ",

abstract = "Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain.Objective: To identify and compare different tests to diagnose fBOO through a systematic review process.Evidence Acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4th 2020. Studies on women >18 years with suspected BOO involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles and performed data extraction. The risk of bias was assessed using QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/- fluoroscopy were evaluated in 25 studies. Transperineal doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6- 92.5%, 64.6-93.9%, and 64.1-92.2% respectively.Conclusion: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies +/- fluoroscopy remains the current standard for diagnosing fBOO.Patient Summary: Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies +/- fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women.",

keywords = "Accuracy, Bladder outlet obstruction, Diagnosis, Female, Lower urinary tract symptoms, Test, Urodynamics",

author = "Pang, {Karl H.} and Riccardo Campi and Salvador Arlandis and Kari B{\o} and Chapple, {Christoper R.} and Elisabetta Costantini and Fawzy Farag and Jan Groen and Markos Karavitakis and Lapitan, {Marie Carmela M.} and Margarida Manso and {Monagas Arteaga}, Serenella and Nambiar, {Arjun K.} and {Nic An R{\'i}ogh}, Aisling and Eabhann O'Connor and Osman, {Nadir I.} and Benoit Peyronnet and V{\'e}ronique Ph{\'e} and Sakalis, {Vasileios I.} and N{\'e}ha Sihra and Lazaros Tzelves and {van der vaart}, Huub and Yuhong Yuan and Omar, {Muhammad Imran} and Harding, {Christopher K.}",

note = "Acknowledgements Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.",

year = "2022",

month = jul,

day = "1",

doi = "10.1016/j.euf.2021.09.003",

language = "English",

volume = "8",

pages = "1015--1030",

journal = "European Urology Focus",

issn = "2405-4569",

publisher = "Elsevier",

number = "4",

}

TY - JOUR

T1 - Diagnostic Tests for Female Bladder Outlet Obstruction

T2 - A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

AU - Pang, Karl H.

AU - Campi, Riccardo

AU - Arlandis, Salvador

AU - Bø, Kari

AU - Chapple, Christoper R.

AU - Costantini, Elisabetta

AU - Farag, Fawzy

AU - Groen, Jan

AU - Karavitakis, Markos

AU - Lapitan, Marie Carmela M.

AU - Manso, Margarida

AU - Monagas Arteaga, Serenella

AU - Nambiar, Arjun K.

AU - Nic An Ríogh, Aisling

AU - O'Connor, Eabhann

AU - Osman, Nadir I.

AU - Peyronnet, Benoit

AU - Phé, Véronique

AU - Sakalis, Vasileios I.

AU - Sihra, Néha

AU - Tzelves, Lazaros

AU - van der vaart, Huub

AU - Yuan, Yuhong

AU - Omar, Muhammad Imran

AU - Harding, Christopher K.

N1 - Acknowledgements Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain.Objective: To identify and compare different tests to diagnose fBOO through a systematic review process.Evidence Acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4th 2020. Studies on women >18 years with suspected BOO involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles and performed data extraction. The risk of bias was assessed using QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/- fluoroscopy were evaluated in 25 studies. Transperineal doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6- 92.5%, 64.6-93.9%, and 64.1-92.2% respectively.Conclusion: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies +/- fluoroscopy remains the current standard for diagnosing fBOO.Patient Summary: Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies +/- fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women.

AB - Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain.Objective: To identify and compare different tests to diagnose fBOO through a systematic review process.Evidence Acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4th 2020. Studies on women >18 years with suspected BOO involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles and performed data extraction. The risk of bias was assessed using QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/- fluoroscopy were evaluated in 25 studies. Transperineal doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6- 92.5%, 64.6-93.9%, and 64.1-92.2% respectively.Conclusion: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies +/- fluoroscopy remains the current standard for diagnosing fBOO.Patient Summary: Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies +/- fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women.

KW - Accuracy

KW - Bladder outlet obstruction

KW - Diagnosis

KW - Female

KW - Lower urinary tract symptoms

KW - Test

KW - Urodynamics

U2 - 10.1016/j.euf.2021.09.003

DO - 10.1016/j.euf.2021.09.003

M3 - Review article

SN - 2405-4569

VL - 8

SP - 1015

EP - 1030

JO - European Urology Focus

JF - European Urology Focus

IS - 4

ER -

Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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