Diagnostic models for male lower urinary tract symptom management in primary care

Harding, Chris, Agarwal, Ridhi, Bates, Janine, Bray, Alison, Milosevic, Sarah ORCID: https://orcid.org/0000-0003-1973-8286, Thomas-Jones, Emma ORCID: https://orcid.org/0000-0001-7716-2786, Drinnan, Michael, Drake, Marcus J, Michell, Peter, Pell, Bethan ORCID: https://orcid.org/0000-0002-0786-6339, Ahmed, Haroon ORCID: https://orcid.org/0000-0002-0634-8548, Joseph-Williams, Natalie ORCID: https://orcid.org/0000-0002-8944-2969, Schatzberger, Tom, Davies, Jane, Hood, Kerenza, Takwoingi, Yemisi and Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 2026. Diagnostic models for male lower urinary tract symptom management in primary care. British Journal of General Practice 10.3399/BJGP.2025.0513

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Abstract

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.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Social Sciences (Includes Criminology and Education) Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Date of First Compliant Deposit:	10 June 2026
Date of Acceptance:	6 April 2026
Last Modified:	04 Aug 2026 21:34
URI:	https://orca.cardiff.ac.uk/id/eprint/187515

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