The evidence-based role of urodynamics in men with lower urinary tract symptoms considering prostate surgery: an international expert consensus
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background and objective
This aim of this international expert consensus project was to clarify the appropriate use of urodynamics (UDS) in men with bothersome lower urinary tract symptoms (LUTS) who are considering prostate surgery in light of high-quality published evidence, particularly high-certainty data from the UPSTREAM study, and expert clinical experience.
Methods
A modified version of the Delphi method was used. Postsurgical patients, catheterised patients, and patients with neurological disease were not included. Eight questions covered UDS in specific contexts; four addressed quality assurance.
Key findings and limitations
Consensus was reached on the need for UDS in any of the following circumstances: if the corrected maximum flow rate is ≥13 ml/s; if bothersome urinary urgency is present; if scores are below stated thresholds for overall symptoms or voiding symptoms; if the postvoid residual volume is considered meaningfully elevated; if there is extensive comorbidity; and if incontinence (any type) is identified. Consensus was not reached on the need for UDS in men with scores below the stated threshold for the impact on quality of life. Consensus was achieved for quality assurance in terms of cross-checking UDS pressure traces and derived indices; ensuring the trustworthiness of traces by experienced health care professionals; and review within the individual clinical context. UDS was considered important when benign prostatic obstruction (BPO) is less likely and in cases in which detrusor underactivity or overactivity is more likely. In cases with severe voiding symptoms, UDS was not considered necessary to increase confidence in recommending surgery to treat LUTS.
This aim of this international expert consensus project was to clarify the appropriate use of urodynamics (UDS) in men with bothersome lower urinary tract symptoms (LUTS) who are considering prostate surgery in light of high-quality published evidence, particularly high-certainty data from the UPSTREAM study, and expert clinical experience.
Methods
A modified version of the Delphi method was used. Postsurgical patients, catheterised patients, and patients with neurological disease were not included. Eight questions covered UDS in specific contexts; four addressed quality assurance.
Key findings and limitations
Consensus was reached on the need for UDS in any of the following circumstances: if the corrected maximum flow rate is ≥13 ml/s; if bothersome urinary urgency is present; if scores are below stated thresholds for overall symptoms or voiding symptoms; if the postvoid residual volume is considered meaningfully elevated; if there is extensive comorbidity; and if incontinence (any type) is identified. Consensus was not reached on the need for UDS in men with scores below the stated threshold for the impact on quality of life. Consensus was achieved for quality assurance in terms of cross-checking UDS pressure traces and derived indices; ensuring the trustworthiness of traces by experienced health care professionals; and review within the individual clinical context. UDS was considered important when benign prostatic obstruction (BPO) is less likely and in cases in which detrusor underactivity or overactivity is more likely. In cases with severe voiding symptoms, UDS was not considered necessary to increase confidence in recommending surgery to treat LUTS.
Date Issued
2026-06-01
Date Acceptance
2025-12-31
Citation
European Urology Focus, 2026, 12 (3), pp.527-538
ISSN
2405-4569
Publisher
Elsevier
Start Page
527
End Page
538
Journal / Book Title
European Urology Focus
Volume
12
Issue
3
Copyright Statement
© 2026 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
License URL
Identifier
10.1016/j.euf.2025.12.018
Publication Status
Published
Date Publish Online
2026-01-14