2022 Review of the Clinical Value of Urodynamic Studies

The vast majority of clinicians, experts, and medical bodies agree that urodynamic studies (UDS) have real clinical value. However, certain clinical studies have questioned the efficacy of urodynamics for certain groups of patients with specific health conditions. 

Many clinicians want to know: Does the data back up the commonly held idea that urodynamic studies are worth it to patients and providers? Are these diagnostic tools merely clarifying complex issues or punching above their weight by helping to deliver deep diagnostic value? 

These questions are by no means simple. To find answers, we looked at a recent meta-analysis that's been making the rounds – Here's what we took away from the experience.

The Meta-study

We reviewed the 2022 paper "Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis." This study, published in European Urology Open Science, explored how eight different trials informed the diagnosis and treatment of lower urinary tract symptoms.

Of the eight studies, six concentrated on a specific patient group: women who had pure or predominant stress urinary incontinence (SUI). In total, the meta-analysis assessed outcomes for some 942 female patients. 

The Findings

So what did the paper say about the clinical value of UDS? One of the biggest takeaways from this study was that the issue is nuanced and underexplored. 

On one hand, the researchers concluded that based on the data, there was little to say that UDS played a definitive role in patient outcomes. In the same breath, however, the authors acknowledged that UDS diagnostics were irreplaceable, stating that there was no other equivalent method for getting to the heart of lower urinary tract problems.

While this may seem like a non-answer, the researchers dove further. They may have had to hedge their bets on providing a definitive yes or no, but this wasn't so much a reflection on UDS itself – Instead, it hinted at the poor state of available research.

Getting Into the Literature

Many of the studies were at risk of bias. For instance, we already mentioned that seventy-five percent of the studies reviewed concentrated on SUI patients. Although UDS may indeed have low value in women with mild forms of stress incontinence, the authors said that the findings for this subgroup didn't extrapolate well to other populations. 

In other words, there wasn't an apples-to-apples comparison that imbued the team with sufficient confidence to draw similar conclusions about managing other kinds of lower urinary tract symptoms (LUTS). Groups like male LUTS sufferers potentially in need of prostate surgery, patients with predominant urgency, and individuals with voiding symptoms were under-investigated.

Another problem was the fact that the studies varied widely in terms of sample size and quality. For instance, the researchers were able to uncover a wealth of different UDS studies, yet they found that the literature still lacked depth. There wasn't enough randomized research on urodynamics' impacts on specific patient groups, including overactive bladder sufferers and individuals who had LUTS along with bladder outlet obstruction risk factors.

So where did urodynamics help patients? According to the research, a few specific groups derive sound value from diagnostic regimens that include UDS, such as:

• Women who develop new overactive bladder symptoms that might indicate bladder outlet obstructions following their mid-urethral sling surgeries,
• Patients who present nocturia and frequent voiding without urinary incontinence, for whom UDS can help rule out causes like an overactive detrusor muscle, potentially avoiding invasive, costly treatments,
• Individuals who've previously failed lower urinary tract surgeries or have neurogenic lower urinary tract dysfunctions, and
• Men who received urodynamics assessments before undergoing surgeries to deal with secondary LUTS associated with benign prostate enlargements.

The Clinical Future of Urodynamic Studies

Again, it's essential to stress that this study's authors maintained that UDS is an invaluable – and likely rightfully recommended – tool in a wide range of cases. Referring to it as the "gold standard," the reviewers noted that even if urodynamics has low value for some patients, it still deserves its place in urological caregiving at large.

If we took anything from this work, it was that there's just not enough evidence – not that the evidence is in favor of or against UDS. 

Even though there are situations where urodynamics may prove minimally valuable, the same might be said of any diagnostic tool. Furthermore, multiple studies implicate UDS as a helpful asset for clinicians and patients in specific circumstances – and such applications are worthy of further investigation.