Christopher R. Chapple, BSc, MBBS, MD, FRCS (Urol), FEBU, FCSHK (Hon), presents “Selective Use of Urodynamics in Lower Urinary Tract Symptoms (LUTS).”
How to cite: Chapple CR. “Selective Use of Urodynamics in Lower Urinary Tract Symptoms (LUTS).” Grand Rounds in Urology. Published September 10, 2025. Accessed Apr 2026. https://grandroundsinurology.com/selective-use-of-urodynamics-in-lower-urinary-tract-symptoms-luts/
Selective Use of Urodynamics in Lower Urinary Tract Symptoms (LUTS) – Summary
Why Watch: Practical guidance on when invasive urodynamics – specifically pressure-flow studies – meaningful change management, and when a structured clinical assessment and bladder diary suffice for lower urinary tract symptoms (LUTS).
Professor Christopher R. Chapple, BSc, MBBS, MD, FRCS (Urol), FEBU, FCSHK (Hon), discusses with Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Senior Editorial Director, Grand Rounds in Urology, how to apply urodynamics judiciously in contemporary practice. Symptoms are not disease-specific, so clinicians should begin with a structured history, examination, and bladder diary, recognizing that storage complaints often dominate presentations in both men and women. British Urologist Richard Turner-Warwick’s adage that “the bladder is an unreliable witness,” underscores the limits of symptom-based diagnosis and the need to confirm pathophysiology before irreversible interventions. The International Continence Society (ICS) standardization remains central to consistent terminology and testing.
Two large UK randomized controlled trials examined routine, unselected use of pressure–flow studies. In men considering surgery for LUTS, the UPSTREAM trial found that a pathway including routine urodynamics did not improve global outcomes versus a strategy without it, supporting selective rather than universal testing. Subgroup and exploratory analyses, however, suggest that urodynamics can refine risk and help identify patients at a higher likelihood of unfavorable outcomes if treated empirically. In women with refractory overactive bladder (OAB), the FUTURE study similarly addresses whether routine invasive testing improves outcomes, with emerging results indicating that some patients can avoid invasive urodynamics without compromising care, again emphasizing patient selection. These data, coupled with real-world variability in test quality, argue that urodynamics should be performed by trained personnel and used to resolve specific diagnostic uncertainty, for example to distinguish urodynamic stress incontinence (USI) from urgency-predominant mixed incontinence, or to clarify suspected detrusor underactivity prior to therapy escalation.
The bottom line is to use bladder diaries early and often, reserve pressure–flow studies for targeted questions that alter management, and ensure high-quality technique. For refractory OAB and men with complex LUTS, selective urodynamics remains valuable to increase diagnostic certainty and optimize outcomes.
