Hypothesis / aims of study
Urodynamic investigation remains the gold standard for assessment of lower urinary tract function in women. Despite its widespread use, urodynamics (UDS) is an invasive test which can be uncomfortable for patients and incur additional cost and time [1]. A common application of UDS is to investigate refractory overactive bladder symptoms (OAB) with the aim to observe detrusor overactivity (DO). Ultrasound (US) measurement of bladder wall thickness (BWT) has been previously proposed as an alternative method for identifying DO [2, 3].
We hypothesise that US measurement of BWT is an accurate method for diagnosing DO.
Study design, materials and methods
This review was registered on PROSPERO and the PRISMA guidelines were followed throughout. A literature search was conducted of databases: “Embase”, “Medline”, “PubMed”, “Google Scholar”, and “Open Access Thesis and Dissertation”. Two independent reviewers screened abstracts for inclusion (see figure 1 and table 1). A risk of bias assessment was conducted using Robins-I V2 tool. Meta-analysis was conducted with exclusion of one study to reduce data heterogeneity. Statistical analysis was conducted using IBM SPSS Statistics.
Interpretation of results
The mean difference between BWT measured in those “with DO” and those “without DO” is statistically different. However, the spread of measurements taken is broad meaning that variance and confidence intervals about this mean are large (i.e. the distribution of data is wide and flat about the mean) and effect size crosses the no effect value (see figure 3). This means that ultrasound measurement of BWT is ineffective for diagnosis of DO and this approach cannot be used to replace urodynamics.