RESUMO
OBJECTIVES: To 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). DESIGN: Systematic review with best evidence synthesis. SETTING: Primary care. PARTICIPANTS: Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS: PubMed, 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. RESULTS: Of 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. CONCLUSION: Clinicians 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.
Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Atenção Primária à Saúde , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Reprodutibilidade dos Testes , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
DESIGN: Cross sectional. OBJECTIVE: To fill a gap in the validation of the active straight leg raising (ASLR) test concerning the relation between a patient's subjective score on the ASLR test and the objective measured force. SUMMARY OF BACKGROUND DATA: The ASLR test is used to classify patients presenting with pain in the low back and/or pelvic girdle. Although its reliability and validity have been demonstrated, some details are still lacking. METHODS: The ASLR test was performed by 21 parous women with various ASLR scores. Subjective weakness was scored by the patient both with and without a pelvic belt; moreover the isometric forces of leg raising were measured. RESULTS: The correlation coefficients between the subjective ASLR score and objective measured force at 0 and 20 cm elevation were -0.58 (P < 0.01) and -0.52 (P < 0.05), respectively, at the left side; and -0.45 (P < 0.05) and -0.63 (P < 0.01), respectively, at the right side. When measured with a pelvic belt the correlations were, respectively, -0.51 and -0.48 at the left side, and -0.47 and -0.50 at the right side (all P < 0.05). After applying a pelvic belt the mean subjective ASLR score decreased with 0.38 point at the left side and 0.48 point at the right side (both P < 0.05). With the belt, the measured force at 0 cm elevation increased by 11.6% (P < 0.001) at the left side and by 8.6% (P < 0.05) at the right side; at 20 cm elevation the changes in measured force were negligible. No significant correlation was found between the subjective and the objective changes elicited by the pelvic belt. CONCLUSION: The subjective scores on the ASLR test correlate well with the objective measured forces; this supports the reliability of the ASLR test. The subjective influence of a pelvic belt on the ASLR score could not be objectified.