Urodynamics in the Evaluation and Management of Bothersome Lower Urinary Tract Symptoms in Men With a Prostate.

Introduction: Despite their utility, urodynamics (UDS) are associated with medical risks and patient discomfort. Therefore, it is crucial to select patients for UDS where the results are likely to change clinical decision-making or solidify diagnostic confidence. This narrative review aims to assess the indications, benefits and limitations of UDS in men with a prostate who have refractory lower urinary tract symptoms.

Methods: A comprehensive review of the literature was conducted, focusing on studies evaluating the utility, patient perspectives, and clinical guidelines related to the use of UDS.

Results: UDS are beneficial in specific clinical scenarios, such as in patients with neurogenic lower urinary tract dysfunction (NLUTD) or when the likelihood of successful intervention is uncertain. For men with suspected BPH, routine UDS before surgical intervention may not be necessary unless there are comorbid conditions such as frailty or a history of radiation that exacerbate risk of surgery or in the presence of significant diagnostic uncertainty, such as in men with suspected neurogenic lower urinary tract dysfunction.

Conclusions: UDS should be selectively utilized in clinical practice to maximize their diagnostic and therapeutic benefits while minimizing patient discomfort and risks. In men with suspected BPH, UDS should be considered in cases with diagnostic uncertainty or in the presence of significant comorbidities. Further research is needed to refine the indications for UDS and to develop noninvasive alternatives that can provide similar diagnostic insights.