Objectives - To 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 lower urinary tract symptoms (LUTS) presenting to primary care. Design - A prospective, multicentre, diagnostic accuracy study with independent development and validation cohorts. Setting - 67 general practices in England and Wales. Participants - 601 men presenting to primary care with LUTS: 350 in the development cohort and 251 in the validation cohort. Interventions -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 were developed and validated in independent cohorts. Main outcome measures - 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. Results - The 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).. Conclusions - Using 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.
The British journal of general practice : the journal of the Royal College of General Practitioners. 2026 Jun 04 [Epub ahead of print]
Chris Harding, Ridhi Agarwal, Janine Bates, Alison Bray, Sarah Milosevic, Emma Thomas-Jones, Michael Drinnan, Marcus J Drake, Peter Michell, Bethan Pell, Haroon Ahmed, Natalie Joseph-Williams, Tom Schatzberger, Jane Davies, Kerenza Hood, Yemisi Takwoingi, Adrian Edwards
Newcastle Upon Tyne Hospitals NHS Trust, Department of Urology, Newcastle upon Tyne, United Kingdom., University of Birmingham, Institute of Applied Health Research, Birmingham, United Kingdom., Cardiff University Centre for Trials Research, Cardiff, United Kingdom., Newcastle University, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom., Cardiff University, Cardiff, United Kingdom., Teesside University, Middlesbrough, United Kingdom., Imperial College London, London, United Kingdom., Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom., Cardiff University, Division of Population Medicine, Cardiff, United Kingdom., Cardiff University, Division of Population Medicine, School of Medicine, Cardiff, United Kingdom., Sele Medical Practice, Hexham, United Kingdom., University of Birmingham, Birmingham, United Kingdom., Cardiff University, Cardiff, United Kingdom .