Non-invasive clinical parameters for the prediction of urodynamic bladder outlet obstruction: analysis using causal Bayesian networks.
OBJECTIVE
To identify non-invasive clinical parameters to predict urodynamic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) using causal Bayesian networks (CBN).


METHODS
From October 2004 to August 2013, 1,381 eligible BPH patients with complete data were selected for analysis. The following clinical variables were considered: age, total prostate volume (TPV), transition zone volume (TZV), prostate specific antigen (PSA), maximum flow rate (Qmax), and post-void residual volume (PVR) on uroflowmetry, and International Prostate Symptom Score (IPSS). Among these variables, the independent predictors of BOO were selected using the CBN model. The predictive performance of the CBN model using the selected variables was verified through a logistic regression (LR) model with the same dataset.


RESULTS
Mean age, TPV, and IPSS were 6.2 (±7.3, SD) years, 48.5 (±25.9) ml, and 17.9 (±7.9), respectively. The mean BOO index was 35.1 (±25.2) and 477 patients (34.5%) had urodynamic BOO (BOO index ≥40). By using the CBN model, we identified TPV, Qmax, and PVR as independent predictors of BOO. With these three variables, the BOO prediction accuracy was 73.5%. The LR model showed a similar accuracy (77.0%). However, the area under the receiver operating characteristic curve of the CBN model was statistically smaller than that of the LR model (0.772 vs. 0.798, p = 0.020).


CONCLUSIONS
Our study demonstrated that TPV, Qmax, and PVR are independent predictors of urodynamic BOO.
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Myong
M
Kim
Department of Computer Science, School of Computing and Information Sciences, Florida International University, Miami, FL, United States of America.
Abhilash
A
Cheeti
Department of Biostatistics, Robert Stempel College of Public health & Social Work, Florida International University, Miami, FL, United States of America.
Changwon
C
Yoo
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Minsoo
M
Choo
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Jae-Seung
JS
Paick
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Seung-June
SJ
Oh
D000368:Aged; D001499:Bayes Theorem; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000503:physiopathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000150:complications / Q000175:diagnosis; D012720:Severity of Illness Index; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014563:Urodynamics
D017430:Prostate-Specific Antigen