For Bladder Outlet Obstruction, Scans Best for Diagnosis
the MPR take:
A new study in the Journal of the American Medical Association has determined that when it comes to diagnosing bladder outlet obstruction, symptoms alone may not be adequate in patients with lower urinary tract symptoms. The objective of the review was to evaluate the evidence regarding the diagnostic accuracy of office-based tests for bladder outlet obstruction in men with lower urinary tract symptoms and the accuracy of the bladder scan as a measure of postvoid bladder residual volumes. Ten studies of 1,262 patients were identified for the bladder outlet obstruction objective and 20 studies of 1,397 patients for the bladder scan objective. The likelihood ratios of individual symptoms and questionnaires for diagnosing bladder outlet obstruction had 95% CIs that included 1.0, suggesting no significant association. No data on the accuracy of physical examination findings on predicting bladder outlet obstruction were located, but urine volumes measured by a bladder scanner were highly associated with urine volumes as measured by bladder catheterization. Thus, the authors recommend a bladder scan for urine volume to accurately diagnose patients with lower urinary tract symptoms and suspected large postvoid bladder residual volumes.
Importance: Early, accurate diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms may reduce the need for invasive testing (ie, catheter placement, urodynamics), and prompt early treatment to provide symptomatic relief and avoid complications. ObjectivesTo systematically ...
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