Noninvasive Diagnosis of Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms Using Ultrasound Decorrelation Analysis

Arif, Muhammad; Groen, Jan; Boevé, Egbert R.; Korte, Chris L. de; Idzenga, Tim; Mastrigt, Ron van

doi:10.1016/j.juro.2016.02.2966

Cited by 8 publications

(13 citation statements)

References 14 publications

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“…Transperineal ultrasound uroflowmetry with a radio frequency reflection measurement to evaluate BOO was compared with pressure flow studies, and demonstrated a high ROC-AUC of 0.96, and good sensitivity (88%) and specificity (95%). 25 The COSMIN score was fair for criterion validity. Based on the COSMIN scores from one study with a sample size of n=45, the level of evidence was graded as low to evaluate BOO using transperineal ultrasound uroflowmetry (see table 5 ).…”

Section: Resultsmentioning

confidence: 96%

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

et al. 2022

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ObjectivesTo systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS).DesignSystematic review with best evidence synthesis.SettingPrimary care.ParticipantsMen with LUTS due to bladder outlet obstruction or benign prostatic obstruction.Review methodsPubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis.ResultsOf the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence.ConclusionClinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.

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Section: Resultsmentioning

confidence: 96%

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

et al. 2022

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“…Our new phantoms would suitably address such need. They can particularly be used as calibration tools for existing urodynamic imaging methods that involve clinical ultrasound scanners …”

Section: Discussionmentioning

confidence: 99%

“…As such, our development of a BPH‐featured urethra phantom serves not only as a case demonstration of the application of our protocol, but also as an investigative tool that can provide insight into the hydrodynamic interactions in the urethra when BPH is present. Representative results will be shown using ultrasound imaging, which is well regarded to be suitable for urodynamic investigations …”

Section: Introductionmentioning

confidence: 99%

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

Ishii

Nahas

et al. 2019

Medical Physics

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Purpose: Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra. Methods: A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 AE 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 AE 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract. Results: Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 AE 0.08 mm) was significantly smaller than that for the normal phantom (2.49 AE 0.20 mm). Also, the maximum flow velocity of the BPHfeatured phantom (59.3 AE 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 AE 9.0 cm/s). Conclusion: The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.

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“…Among them is the ultrasound decorrelation, using flow Doppler to distinguish laminar (normal) from turbulent (obstructed) flow. 38…”

Section: Prostate Size Measurementmentioning

confidence: 99%

“…In addition to existing well known techniques, new imaging modalities may be emerging. Among them is the ultrasound decorrelation, using flow Doppler to distinguish laminar (normal) from turbulent (obstructed) flow …”

Section: Introductionmentioning

confidence: 99%

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

Rademakers

Drake

Gammie

et al. 2017

Neurourology and Urodynamics

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The diagnosis of bladder outlet obstruction (BOO) in the male is dependent on measurements of pressure and flow made during urodynamic studies. The procedure of urodynamics and the indices used to delineate BOO are well standardized largely as a result of the work of the International Continence Society. The clinical utility of the diagnosis of BOO is however, less well defined and there are several shortcomings and gaps in the currently available medical literature. Consequently the International Consultation on Incontinence Research Society (ICI-RS) held a think tank session in 2015 entitled "Male bladder outlet obstruction: Time to re-evaluate the definition and reconsider our diagnostic pathway?" This manuscript details the discussions that took place within that think tank setting out the pros and cons of the current definition of BOO and exploring alternative clinical tests (alone or in combination) which may be useful in the future investigation of male patients with lower urinary tract symptoms. The think tank panel concluded that pressure-flow studies remain the diagnostic gold-standard for BOO although there is still a lack of high quality evidence. Newer, less invasive, investigations have shown promise in terms of diagnostic accuracy for BOO but similar criticisms can be levelled against these tests. Therefore, the think tank suggests further research with regard to these alternative indicators to determine their clinical utility.

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Noninvasive Diagnosis of Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms Using Ultrasound Decorrelation Analysis

Abstract: It is possible to noninvasively diagnose bladder outlet obstruction using the ultrasound decorrelation technique.

Cited by 8 publications

References 14 publications

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

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