Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Karl H. Pang, Riccardo Campi, Salvador Arlandis, Kari Bø, Christoper R. Chapple, Elisabetta Costantini, Fawzy Farag, Jan Groen, Markos Karavitakis, Marie Carmela M. Lapitan, Margarida Manso, Serenella Monagas Arteaga, Arjun K. Nambiar, Aisling Nic An Ríogh, Eabhann O'Connor, Nadir I. Osman, Benoit Peyronnet, Véronique Phé, Vasileios I. Sakalis, Néha SihraLazaros Tzelves, Huub van der vaart, Yuhong Yuan, Muhammad Imran Omar* (Corresponding Author), Christopher K. Harding

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)
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Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to 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 PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4th 2020. Studies on women >18 years with suspected 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 QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/- fluoroscopy were 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 meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6- 92.5%, 64.6-93.9%, and 64.1-92.2% respectively.Conclusion: 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.
Original languageEnglish
Pages (from-to)1015-1030
Number of pages16
JournalEuropean Urology Focus
Issue number4
Early online date17 Sept 2021
Publication statusPublished - 1 Jul 2022

Bibliographical note

Jae Hung Jung, Murat Gul, Ege Can Serefoglu (translation of foreign language articles) and Karin Plass for administrative support.

Data Availability Statement

Supplementary data
Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.


  • Accuracy
  • Bladder outlet obstruction
  • Diagnosis
  • Female
  • Lower urinary tract symptoms
  • Test
  • Urodynamics


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