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

CONTEXT

Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared with 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 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4, 2020. Studies on women ≥18 yr of age with suspected bladder outlet obstruction (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 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

EVIDENCE SYNTHESIS

Overall, 28 nonrandomised studies involving 10 248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (ie, mixed cohorts including both anatomical and functional BOO). Pressure-flow studies ± fluoroscopy was 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 a meta-analysis. Three studies derived nomograms using the maximum flow rate (Q_max) and voiding detrusor pressure at Q_max. The sensitivity, specificity, and overall accuracy ranges were 54.6-92.5%, 64.6-93.9%, and 64.1-92.2%, respectively.

CONCLUSIONS

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. TAKE  HOME MESSAGE: The available evidence on diagnostic tests for female bladder outlet obstruction is limited and heterogeneous. The most common test used was video-urodynamics, which remains the current standard for diagnosing bladder outlet obstruction in women.

Designing and assessing a urethral catheter skills workshop for intern doctors in a university teaching hospital

BACKGROUND

Urethral catheterisation (UC) is a frequently performed medical procedure and catheter-related injuries can lead to significant morbidity for patients. The aims of this study are to assess interns' exposure to UC and to design, implement and assess a structured UC skills workshop for hospital interns.

METHODS

A 10-item anonymous questionnaire on UC was distributed to interns in two university teaching hospitals. Respondents were invited to participate in a skills workshop. Teaching methods for correct UC technique included a lecture, a video tutorial and a simulated patient model. Participants' catheter insertion skills were assessed using a 20-item OSCE checklist when the UC workshop concluded.

RESULTS

In total, 40 interns completed the initial questionnaire of whom 26 (65%) had not received any dedicated catheter skills training prior to commencing internship. Fourteen (35%) were unsupervised during their first UC. Fifteen (37%) interns attended the dedicated skills workshop. All interns found the workshop beneficial and 12 (80%) reported an improvement on confidence afterwards. Following the workshop, the mean (± standard deviation) catheter insertion OSCE score was 92% (± 14.1).

CONCLUSIONS

Interns have a lack of knowledge, experience and confidence with catheter insertion. Current training models are deficient. The introduction of a structured skills workshop may help to improve catheter insertion skills among interns.