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.