Evidence Table 3Diagnosistic accuracy of uroflowmetry

Study detailsPatientsDiagnostic toolsMeasure of DisordersResultsComments
Ref ID: Oelke et al., 2007231

Study design:
Cross-sectional study

Evidence level:
Level-2 study (II)

Duration of follow-up:
1-3 weeks duration between the index test and the gold standard
Patient group: Men with LUTS, clinical BPH and/or prostate volume >25ml

Setting: single centre – urologic outpatient clinic - Germany

Inclusion criteria: Exclusion criteria:
Patients with: All patients
N: 160
Age median (range): 62 (40-89)
Drop outs: 0
Assessment tool under investigation:
Uroflowmetry – number of voids not specified.

Gold standard:
Pressure flow studies (PFS) performed using Ellipse (Andromeda) machine with CHESS used to classify obstruction
Qmax threshold < 10 mL/sFunding:
NR

Limitations:
Details of Uroflowmetry methods not reported

1-3 week delay between

Uroflowmetry as index test and PFS
No mention whether the procedures tested were conducted by the same investigator(s)

Additional outcomes:
This study also reports Detrusor Wall Thickness measured by 7.5 MHz ultrasound, Post Void Residual measured with 3.5 MHz ultrasound. Prostate Volume measured with TRUS

Notes:
None
Sensitivity68% (51/75) CI95% 57 - 79
Specificity73% (62/85) CI95% 64 - 82
Positive predictive value69% (51/74)
Negative predictive value72% (62/86)
Prevalence47% 75/160
Positive Likelihood Ratio2.51
Negative Likelihood Ratio0.44
Pre-test Odds (CI 95%)0.88 (CI95%: 0.81-0.96)
Post-Test Odds +ve result2.22
Post-Test Odds -ve result0.39
Qmax threshold < 15 mL/s
Sensitivity99% (74/75) CI95% 97 - 100
Specificity39% (33/85) CI95% 29 - 49
Positive predictive value59% (74/126)
Negative predictive value97% (33/34)
Prevalence47% 75/160
Positive Likelihood Ratio1.61
Negative Likelihood Ratio0.03
Pre-test Odds (CI 95%)0.88 (CI95%: 0.81-0.96)
Post-Test Odds +ve result1.42
Post-Test Odds -ve result0.03
Study detailsPatientsDiagnostic toolsMeasure of DisordersResultsComments
Ref ID: Poulsen et al., 1994241

Study design:
Cross-sectional study

Evidence level:
Level-2 study (II)

Duration of follow-up:
NA
Patient group: Men with symptomatic BPH (94% uncomplicated), 5% also with recurrent urinary tract infection and 1% with previous AUR

Setting: single centre Denmark

Exclusion criteria:
NR

All patients
N: 188
Age median (range): 68 (32-90)
Drop outs:
Free flow missing for 35/188 (19%) and PFS data missing for 5/188 (3%)
Assessment tool under investigation:
Void into Dantec Urodyn 1000 uroflowmeter. Number of voids not reported

Gold standard:
Pressure flow studies (PFS) performed using Dantec Urodyn 1000 uroflowmeter after filling with Foley 14F catheter. Patients characterised for BOO using Abrams-Griffiths nomogram.
Qmax threshold < 10 mL/sFunding: NR

Limitations:
Masking of assessors to test results NR

Not clear whether tests were independent (implies PFS before entry into study)

Number of voids NR

Additional outcomes:
DAN-PSS Symptom Score also recorded

Notes:
None
Sensitivity69% (68/99) CI95%: 59 - 78
Specificity57% (31/54) CI95%: 44 - 70
Positive predictive value75% (68/91)
Negative predictive value50% (31/62)
Prevalence65% (99/153)
Positive Likelihood Ratio1.61
Negative Likelihood Ratio0.55
Pre-test Odds (CI 95%)1.83 (CI95%: 1.76 -1.91)
Post-Test Odds +ve result2.96
Post-Test Odds -ve result1.00
Qmax threshold < 15 mL/s
Sensitivity90% (89/99) CI95%: 84 - 96
Specificity31% (17/54) CI95%: 19 - 43
Positive predictive value71% (68/91)
Negative predictive value63% (31/62)
Prevalence65% (99/153)
Positive Likelihood Ratio1.31
Negative Likelihood Ratio0.32
Pre-test Odds (CI 95%)1.83 (CI95%: 1.76 -1.91)
Post-Test Odds +ve result2.41
Post-Test Odds -ve result0.59
Study detailsPatientsDiagnostic toolsMeasure of DisordersResultsComments
Ref ID: Reynard et al., 1996248

Study design:
Cross-sectional study

Evidence level:
Level-2 study (II)

Duration of follow-up:
NA
Patient group: Men > 45 years with) LUTS suggestive of benign prostatic obstruction (BPO)

Setting: 2 centres UK

Exclusion criteria:
Patients with: All patients
N: 165
Age median (range): 68 (50-84)
Drop outs:
PFS data missing for 8/165 (5%) patients
Assessment tool under investigation:
Uroflowmetry 4 voids into Dantec Urodyn 1000 uroflowmeter. Qmax below threshold indicates BOO

3 voids: 17 (10%)
4 voids: 148 (90%)

Gold standard:
Pressure flow studies (PFS) performed using Dantec Menuet or Dantec 5500 multichannel recorder. Patients characterised for BOO using Abrams-Griffiths nomogram as obstructed or equivocal/ unobstructed.
*Qmax threshold < 10 mL/sFunding:
NR

Limitations:
No indication of who carried out the tests-whether by the same people, or whether the investigator or patients were masked to the results of other tests.

Results of individual centres not compared, and inter-rater agreement (presumably tests in different tests done by different people) was not addressed

Notes:
*Qmax taken as highest value on voids 1 & 2.
Also reported < 8 mL/s

Study suggests increasing specificity and decreasing specificity with increasing number of voids
Sensitivity49% (47/95) CI95% 39 - 59
Specificity87% (54/62) CI95% 79 - 95
Positive predictive value85%
Negative predictive value53%
Prevalence61% (95/157)
Positive Likelihood Ratio3.83
Negative Likelihood Ratio0.58
Pre-test Odds (CI 95%)1.53 (CI95%:1.46 -1.61)
Post-Test Odds +ve result5.88
Post-Test Odds -ve result0.89
*Qmax threshold < 12 mL/s
Sensitivity65% (62/95) CI95% 55 - 75
Specificity74% (46/62) CI95% 79 - 95
Positive predictive value79%
Negative predictive value58%
Prevalence61% (95/157)
Positive Likelihood Ratio2.53
Negative Likelihood Ratio0.47
Pre-test Odds (CI 95%)1.53 (CI95%:1.46 -1.61)
Post-Test Odds +ve result3.88
Post-Test Odds -ve result0.72
*Qmax threshold < 15 mL/s
Sensitivity85% (81/95) CI95% 78 - 92
Specificity53% (33/62) CI95% 63 - 85
Positive predictive value74%
Negative predictive value70%
Prevalence61% (95/157)
Positive Likelihood Ratio1.82
Negative Likelihood Ratio0.38
Pre-test Odds (CI 95%)1.53 (CI95%:1.46 -1.61)
Post-Test Odds +ve result2.79
Post-Test Odds -ve result0.42

From: Appendix D, Evidence Tables

Cover of The Management of Lower Urinary Tract Symptoms in Men
The Management of Lower Urinary Tract Symptoms in Men [Internet].
NICE Clinical Guidelines, No. 97.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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