Leerssen Eeke C M, Lindeboom Sanne N S, Chrzan Rafal, Abbas Tariq O, Garvelink Mirjam, Schroeder Rogier P J
University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Department of Pediatric Urology, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, the Netherlands.
University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
J Pediatr Urol. 2024 Dec;20(6):1142-1151. doi: 10.1016/j.jpurol.2024.07.026. Epub 2024 Aug 2.
Infravesical obstruction (IO) is a common urological condition in young boys. Patients may present with various signs and symptoms at different ages, with severity depending to a large extent on the degree of obstruction. Consensus concerning accurate and objective modalities to diagnose IO and to differentiate between an anatomical or functional cause is still lacking.
This study aimed to reach consensus on the diagnostic determinants that are important to assess the likelihood of anatomical IO in boys and differentiate between an anatomical or functional cause.
A Delphi method was used to establish a list of diagnostic determinants that can be utilized in order to diagnose anatomical IO in boys. An international and interdisciplinary panel of experts was recruited to reach consensus using three sequential rounds of electronic questionnaires. Data were collected using the online survey platform Qualtrics. Rounds one and two were used to define diagnostic determinants. Round three was used to stratify key determinants according to age.
All rounds received a response rate of 100%. In round one, consensus was achieved on 44 of a total 79 items. In round two, consensus was achieved on 19 of a total 51 items. Round three identified a variation in key determinants per age group.
To create an effective tool for assessing IO in boys, key determinants identified in this study will need to be validated in a prospective clinical trial. Due to a large number of determinants and sections, this will not be a trivial task. In addition, since a Delphi study is based on expert opinion, any consensus achieved remains subjective. Diagnostic determinants identified in this study will need to be validated using prospective clinical data. Artificial Intelligence provides techniques for uncovering complex associations that cannot easily be reduced to equations. It may therefore play a pivotal role in the future development of robust IO risk assessment tools.
An international group of experts agreed that a risk assessment tool for IO in boys would be beneficial for both clinical practice and research purposes. Using a Delphi study methodology, consensus was reached on a set of diagnostic determinants that were considered important to assess the likelihood of IO and differentiate between an anatomical or functional cause. This study paves the way for further research on IO in boys. Eventually this could lead to an accurate and standardized assessment tool for IO.
膀胱下梗阻（IO）是年轻男性常见的泌尿系统疾病。患者在不同年龄段可能出现各种体征和症状，严重程度在很大程度上取决于梗阻程度。目前仍缺乏关于准确、客观诊断IO以及区分解剖学或功能性病因的一致方法。
本研究旨在就对评估男性解剖学IO可能性及区分解剖学或功能性病因至关重要的诊断决定因素达成共识。
采用德尔菲法建立一份可用于诊断男性解剖学IO的诊断决定因素清单。招募了一个国际跨学科专家小组，通过三轮连续的电子问卷达成共识。使用在线调查平台Qualtrics收集数据。第一轮和第二轮用于确定诊断决定因素。第三轮用于根据年龄对关键决定因素进行分层。
所有轮次的回复率均为100%。在第一轮中，在总共79项中的44项上达成了共识。在第二轮中，在总共51项中的19项上达成了共识。第三轮确定了各年龄组关键决定因素的差异。
为创建一种评估男性IO的有效工具，本研究确定的关键决定因素需要在前瞻性临床试验中进行验证。由于决定因素和部分数量众多，这并非易事。此外，由于德尔菲研究基于专家意见，达成的任何共识仍然是主观的。本研究确定的诊断决定因素需要使用前瞻性临床数据进行验证。人工智能提供了揭示难以简化为方程的复杂关联的技术。因此，它可能在强大的IO风险评估工具的未来发展中发挥关键作用。
一组国际专家一致认为，针对男性IO的风险评估工具对临床实践和研究目的均有益。采用德尔菲研究方法，就一组诊断决定因素达成了共识，这些因素被认为对评估IO可能性及区分解剖学或功能性病因很重要。本研究为进一步研究男性IO铺平了道路。最终这可能会产生一种准确、标准化的IO评估工具。
