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Non-surgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness

Slide: 26 of 50

Results of the Systematic Review: Evaluation of Diagnostic Methods (3 of 4)

Clinical algorithms for diagnosis of urinary incontinence were evaluated in comparison with the full clinical diagnosis or multichannel urodynamics. Some examples of this analysis are presented here.

To evaluate the EPIQ (Epidemiology of Incontinence Questionnaire)-based algorithm for accuracy in diagnosing stress UI, the algorithm was compared with complete clinical diagnosis. The sensitivity of the EPIQ algorithm was 0.65 (statistically valid range of 0.36 to 0.86). Specificity was 0.54 (statistically valid range of 0.21 to 0.84). The positive likelihood ratio was 10, which is defined as large diagnostic value. The positive predictive value was calculated at 0.88.

The EPIQ-based algorithm was evaluated in comparison with clinical diagnosis for accuracy in diagnosing urgency UI due to detrusor overactivity. The sensitivity of the EPIQ algorithm was 0.82 (statistically valid range of 0.73 to 0.89). Specificity was 0.67 (statistically valid range of 0.53 to 0.89). The positive likelihood ratio was 7.7, which is defined as large diagnostic value. The positive predictive value was calculated at 0.77.

The Overactive Bladder Awareness Tool (OAB-V8)-based algorithm was evaluated in comparison with clinical diagnosis for accuracy in diagnosis of urgency UI due to detrusor overactivity. The sensitivity of the OAB-V8 algorithm was 0.65 (statistically valid range of 0.36 to 0.86). Specificity was 0.54 (statistically valid range of 0.21, 0.84). The positive likelihood ratio was 5.66, which is defined as moderate diagnostic value. The positive predictive value was calculated at 0.44.

The Bladder Instability Discriminant Index (BIDI) algorithm was evaluated in comparison with urodynamics for accuracy in diagnosis of urgency UI due to detrusor overactivity. The sensitivity of the BIDI algorithm was 0.88. Specificity was 0.83. The positive likelihood ratio was 5.12, which is defined as moderate diagnostic value. The positive predictive value was calculated at 0.41. The results are from a single study, and no 95 percent confidence intervals were calculated.

A clinical algorithm, described by Yalcin and colleagues in 2004, was evaluated in comparison with urodynamics for accuracy in diagnosis of stress UI. The sensitivity, specificity, and positive likelihood ratio were not reported. The positive predictive value is 0.90, with a statistically valid range from 0.85 to 0.94.

The clinical algorithm described by Yalcin and colleagues in 2004 was evaluated in comparison with the clinical diagnosis for accuracy in diagnosing stress UI. The sensitivity, specificity, and positive likelihood ratio were not reported. The positive predictive value is 0.85, with a statistically valid range from 0.79 to 0.90.