ABSTRACT
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 (Qmax) and voiding detrusor pressure at Qmax. 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.
Subject(s)
Urinary Bladder Neck Obstruction , Urology , Diagnostic Tests, Routine , Female , Humans , Male , Urinary Bladder , Urinary Bladder Neck Obstruction/diagnosis , UrodynamicsABSTRACT
OBJETIVO: Los tumores metastásicos del pene son muy infrecuentes. Suelen ser una manifestación tardía de la neoplasia primitiva, siendo un signo de mal pronóstico.Se aporta un caso de metastatización peneana de rara presentación cuyo tumor primario fue un adenocarcinoma prostático.MÉTODOS: Se presenta un paciente de 77 años que acude a nuestra Institución con hematuria y retención aguda de orina, detectándose durante la exploración múltiples lesiones induradas en el pene. El paciente es sometido a ecografía Doppler, con posterior biopsia peneana, prostática y estudio de extensión. Actualmente en tratamiento con bloqueo hormonal completo.RESULTADOS: El estudio histológico de la biopsia peneana demostró una metástasis peneana procedente de adenocarcinoma prostático.El estudio histológico de la biopsia prostática objetivó un adenocarcinoma grado combinado Gleason 8 (4+4).CONCLUSIÓN: A pesar de las diferentes alternativas terapéuticas posibles, éstas serán con fin paliativo, ya que la supervivencia media de estos pacientes es inferior al año(AU)
OBJECTIVE: Penile metastases are late manifestations of a primary tumor, and they are a sign of poor prognosis.We report a case of a rare presentation: penile metastases from prostate cancer.METHODS: 77 year-old male presented hematuria and acute urinary retention; on physical examination multiple hard lesions were detected. The patient underwent a Doppler ultrasound, subsequent penile and prostate biopsy, and staging study. Currently he is being treated with complete androgen blockade.RESULTS: A histological study of the penile biopsy showed penile metastasis from prostate adenocarcinoma.The histological study of prostate biopsy confirmed Gleason 8 (4 +4) adenocarcinoma.CONCLUSIONS: Despite of the different therapeutic alternatives for treatment of symptomatic penile metastases, it would be with palliative target; due to the median survival of these patients is less than a year(AU)
