ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2026
Diagnostic models for male lower urinary tract symptom management in primary care: a prospective, multicentre, diagnostic accuracy study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRecent research has concluded that primary care assessment and management of lower urinary tract symptoms (LUTS) requires practical resources.
aimTo develop and independently validate risk-prediction models for three common urological conditions based on a combination of simple, minimally invasive index tests in men with LUTS presenting to primary care. DESIGN AND
settingA prospective, multicentre, diagnostic accuracy study with independent development and validation cohorts set in 67 general practices in England and Wales.
methodA total of 601 men presenting to primary care with LUTS, 350 in the development cohort and 251 in the validation cohort, underwent index tests - validated symptom assessment, bladder diary, physical examination, serum prostate specific antigen, uroflowmetry, and post-void residual volume estimation. Invasive urodynamic studies provided a diagnostic reference standard. Risk-prediction models for urodynamic diagnoses were developed and then validated in independent cohorts. Discriminative and calibration performance of the risk-prediction models for diagnosing bladder outlet obstruction (BOO), detrusor underactivity (DU), and detrusor overactivity (DO) using the c-index, calibration slope and plot, and sensitivity and specificity of the models was undertaken.
resultsThe BOO model from the development cohort demonstrated good discriminative performance (optimism-corrected c-index of 0.80). The models derived from the development cohort for DU and DO demonstrated moderate discriminative ability (optimism-corrected c-indices of 0.64 and 0.67, respectively). Similar estimates of c-index were observed for each model within the independent validation cohort (BOO, 0.82; DU, 0.63; and DO, 0.62).
conclusionUsing a combination of simple, non-invasive index tests can accurately predict common urological diagnoses in men with LUTS, potentially facilitating earlier initiation of evidence-based treatments and improved management in primary care.
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