Beyond urodynamics: non-invasive approaches to diagnosing detrusor underactivity in men with lower urinary tract symptoms – a systematic review

Abstract

Abstract Background To evaluate and synthesize existing evidence on non-invasive methods for diagnosing detrusor underactivity (DU) in men presenting with lower urinary tract symptoms (LUTS), focusing on their feasibility and diagnostic accuracy. Methods A systematic search of PubMed, Scopus, and Web of Science databases was conducted for original articles reporting on non-invasive diagnostic tests for DU in men with LUTS. Data extraction focuses on study characteristics, diagnostic methods, and accuracy. The risk of bias was assessed using the QUADAS-2 tool. Results Eighteen studies involving 7390 patients, of whom 3194 were diagnosed with DU, were included in our analysis. The evaluated diagnostic methods included ultrasound parameters, biomarkers, uroflowmetry results, symptom questionnaires, and clinical characteristics. Developed models, including those based on artificial intelligence (AI), and nomograms were also assessed. The symptom questionnaire DUA-SQ showed the highest sensitivity of 95.8%, while ultrasound measurements, such as detrusor wall thickness showed 100% specificity but limited sensitivity (42%). Models incorporating clinical variables achieved sensitivity rates of over 75%. Uroflowmetry parameters, particularly presence of "sawtooth" and "interrupted" waveforms, demonstrated sensitivity of 80% and specificity of 87%. Biomarkers, including serum adiponectin and urine NO/ATP ratio, achieved sensitivity of 79% and 88.5%, respectively. AI models showed potential, with sensitivities ranging from 65.9% to 79.7%. Due to the poor quality of the studies and data heterogeneity, meta-analysis was not performed. Conclusions Non-invasive diagnostic methods for DU, particularly DUA-SQ, ultrasound measurements, and AI models, demonstrate potential, though their accuracies vary. Further research is needed to standardize these methods and enhance their diagnostic reliability. Trial registration The study protocol was registered with PROSPERO (CRD42024556425). Clinical trial number: not applicable.

Keywords

• Detrusor underactivity
• Non-invasive tests
• Underactive bladder
• Urodynamics
• Pressure flow study
• LUTS