{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:34:21Z","timestamp":1792017261451,"version":"4.4.0"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003052","name":"Ministry of Trade, Industry and Energy","doi-asserted-by":"publisher","award":["RS\u20102025\u201000521596"],"award-info":[{"award-number":["RS\u20102025\u201000521596"]}],"id":[{"id":"10.13039\/501100003052","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF\u20102022R1I1A3073688"],"award-info":[{"award-number":["NRF\u20102022R1I1A3073688"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Differentiating bladder outlet obstruction (BOO) from detrusor underactivity (DU) remains a major unmet need in the management of lower urinary tract symptoms in men. Although pressure\u2013flow urodynamics provide a definitive physiological classification, their invasiveness limits their widespread use. We reviewed why current non\u2010invasive approaches have failed to achieve consistent clinical adoption and explored a pathway toward clinically useful pre\u2010urodynamic triage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This hypothesis\u2010generating narrative review synthesized evidence on non\u2010invasive BOO\/DU assessment, using suprapubic near\u2010infrared spectroscopy (NIRS) as an illustrative example of transcutaneous physiological sensing. We examined the mechanistic, anatomical, and methodological factors that limit signal validity and considered how these constraints affect interpretation across modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Current non\u2010invasive approaches face limitations due to the physiological overlap between BOO and DU, differences in anatomical depth, contamination from abdominal wall activity during voiding, and variations in methodology. Advances in artificial intelligence may help with pattern recognition, but they cannot compensate for uncertainty regarding signal origin or physiological relevance. On the basis of these limitations, we propose a conceptual, non\u2010validated depth\u2010aware multimodal triage framework that combines real\u2010time bladder localization, quality\u2010controlled physiological sensing, and complementary non\u2010invasive parameters. This framework needs prospective validation before clinical implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistent difficulty of non\u2010invasive BOO\/DU differentiation reflects the limitations of the prevailing diagnostic paradigm rather than the shortcomings of any single technology. A depth\u2010aware multimodal approach is not intended to replace urodynamics but may support pre\u2010urodynamic triage, reduce diagnostic uncertainty, and enable more selective use of invasive testing. This framework should be regarded as a hypothesis\u2010generating model for future validation rather than as a clinically implementable diagnostic tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70379","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:55:17Z","timestamp":1784746517000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Non\u2010Invasive Triage of Bladder Outlet Obstruction and Detrusor Underactivity in Men With Lower Urinary Tract Symptoms: A Narrative Review and Conceptual Framework for Depth\u2010Aware Multimodal Transcutaneous Testing"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5491-3732","authenticated-orcid":false,"given":"Sehwan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering School of Medicine, Dankook University Cheonan Republic of Korea"},{"name":"MEDiThings Co. Ltd. Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7339-5451","authenticated-orcid":false,"given":"Bryan K.","family":"Kim","sequence":"additional","affiliation":[{"name":"MEDiThings Co. Ltd. Seoul Republic of Korea"},{"name":"Department of Bioengineering, The Grainger College of Engineering University of Illinois Urbana\u2010Champaign Urbana Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5503-4940","authenticated-orcid":false,"given":"John T.","family":"Stoffel","sequence":"additional","affiliation":[{"name":"Department of Urology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-2262","authenticated-orcid":false,"given":"Aram","family":"Kim","sequence":"additional","affiliation":[{"name":"MEDiThings Co. Ltd. Seoul Republic of Korea"},{"name":"Department of Urology and Neurogenic Bladder Clinic Konkuk University School of Medicine, Konkuk University Medical Center Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"S14","article-title":"Pressure Flow Urodynamic Studies: The Gold Standard for Diagnosing Bladder Outlet Obstruction","volume":"7","author":"Nitti V. W.","year":"2005","journal-title":"Reviews in Urology"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.eururo.2013.10.015","article-title":"Detrusor Underactivity and the Underactive Bladder: A New Clinical Entity? A Review of Current Terminology, Definitions, Epidemiology, Aetiology, and Diagnosis","volume":"65","author":"Osman N. I.","year":"2014","journal-title":"European Urology"},{"key":"e_1_2_12_4_1","article-title":"EAU Guidelines on the Management of Non\u2010Neurogenic Male Lower Urinary Tract Symptoms (LUTS), Incl. Benign Prostatic Obstruction","author":"Cornu J. N.","year":"2026","journal-title":"European Association of Urology"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.eururo.2006.07.050","article-title":"The Detrusor Muscle: An Innocent Victim of Bladder Outlet Obstruction","volume":"51","author":"Mirone V.","year":"2007","journal-title":"European Urology"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1002\/nau.23124","article-title":"International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, Uroflowmetry, Cystometry, and Pressure\u2010Flow Study","volume":"36","author":"Rosier P. F. W. 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