From Clinical Trials to Routine Practice: Are Urodynamics Still Useful?

The UPSTREAM and FUTURE trials found no added benefit from routine urodynamics (UDS) in men with presumed benign prostatic obstruction or women with overactive bladder symptoms unresponsive to initial therapy. However, these population-based studies were not powered to evaluate specific subgroups for which a higher degree of diagnostic certainty could have led to better outcomes. This consensus paper argues that UDS is essential in selected cases for which comprehensive clinical assessment alone may be insufficient. A selective approach to UDS will ensure that patients receive the most accurate diagnosis and appropriate treatment.