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. 2014 Feb 20;9(2):e85474.
doi: 10.1371/journal.pone.0085474. eCollection 2014.

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys

Pauline M L Hennus  1 , Laetitia M O de Kort  1 , J L H Bosch  1 , Tom P V M de Jong  2 , Geert J M G van der Heijden  3
Affiliations

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys

Pauline M L Hennus et al. PLoS One. .

Abstract

Background: Infravesical obstruction leads to kidney and bladder dysfunction in a significant proportion of boys. The aim of this review is to determine the value of diagnostic tests for ascertainment of infravesical obstruction in boys.

Methodology: We searched PubMed and EMBASE databases until January 1, 2013, to identify papers that described original diagnostic accuracy research for infravesical obstruction in boys. We extracted information on (1) patient characteristics and clinical presentation of PUV and (2) diagnostic pathway, (3) diagnostic accuracy measures and (4) assessed risk of bias.

Principal findings: We retrieved 15 studies describing various diagnostic pathways in 1,189 boys suspected for infravesical obstruction. The included studies reflect a broad clinical spectrum of patients, but all failed to present a standardised approach to confirm the presence and severity of obstruction. The risk of bias of included studies is rather high due to work-up bias and missing data.

Conclusions: As a consequence of low quality of methods of the available studies we put little confidence in the reported estimates for the diagnostic accuracy of US, VCUG and new additional tests for ruling in or ruling out infravesical obstruction. To date, firm evidence to support common diagnostic pathways is lacking. Hence, we are unable to draw conclusions on diagnostic accuracy of tests for infravesical obstruction. In order to be able to standardise the diagnostic pathway for infravesical obstruction, adequate design and transparent reporting is mandatory.

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Conflict of interest statement

Competing Interests: The authors have the following interests. This study was funded by Astellas Pharma B.V. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Flow chart.
Figure 2
Figure 2. Diagnostic pathways.
Legend: US = ultrasound, VCUG = voiding cystourethrogram, UCS = urethrocystoscopy. Pathway 1 performs US and VCUG in patients with positive US or in all included patients. Pathway 2 performs US in all, VCUG in patients with positive US and UCS in patients with positive VCUG. Pathway 3 perform US and VCUG in all patients, UCS is performed in patients with positive US and positive VCUG. Pathway 4 performs US, VCUG and UCS in all patients.
See this image and copyright information in PMC

References

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