- Design
- Prospective multicentre diagnostic accuracy study with independent validation
- Population
- 601 men with LUTS in 67 general practices, England and Wales
- Primary outcome
- Prediction of urodynamic diagnoses
- Effect
- Obstruction c-index 0.82; underactivity 0.63; overactivity 0.62 (validation)
A prospective diagnostic accuracy study in the British Journal of General Practice (7 September) recruited 601 men presenting with lower urinary tract symptoms (LUTS) to 67 practices in England and Wales. Each had a symptom score, bladder diary, examination, PSA, flow rate and post-void residual volume, and all had invasive urodynamics as the reference standard. Models were built in 350 men and tested in a separate 251.
The model for bladder outlet obstruction discriminated well (c-index 0.80 in development, 0.82 on validation). Models for detrusor underactivity and overactivity were only moderate (0.63 and 0.62 on validation).
The practical value is in the obstruction model: a man whose non-invasive tests point strongly to obstruction can start appropriate treatment in primary care with more confidence. The weaker models mean an overactive or underactive bladder still needs clinical judgement or referral.
- Ask for a three-day bladder diary before the second appointment
- Measure post-void residual where a bladder scanner is available
- Examine the prostate and check PSA after counselling
- Refer if symptoms suggest underactivity, retention or a raised residual volume
Why it matters
It suggests most men with LUTS can be assessed properly in primary care without invasive testing.
Don't overread it
Flow rate and bladder scanning are not available in every practice, which limits how widely the model applies.
The statistics, in plain English
A c-index of 0.82 means that, given one man with obstruction and one without, the model ranks them correctly about 82% of the time. Values around 0.62 are only a little better than chance. Holding up in a separate validation cohort is what makes the obstruction result credible.
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