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Lookup NU author(s): Professor Christopher HardingORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s)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. Conclusions and clinical implications: UDS retains an important role in men with bothersome LUTS considering surgery for presumed BPO. Our consensus recommends specific criteria to guide selective UDS use.
Author(s): Drake MJ, Iacovelli V, Cruz F, Elterman D, Gammie A, Harding C, Hashim H, Kessler TM, Kirschner-Hermanns R, van Koeveringe G, MacDiarmid S, Malde S, de Nunzio C, Phe V, Rovner E, Solomon E, Tarcan T, Tikkinen KAO, de Wachter S, Finazzi-Agro E
Publication type: Review
Publication status: Published
Journal: European Urology Focus
Year: 2026
Pages: epub ahead of print
Online publication date: 14/01/2026
Acceptance date: 31/12/2025
ISSN (electronic): 2405-4569
Publisher: Elsevier B.V.
URL: https://doi.org/10.1016/j.euf.2025.12.018
DOI: 10.1016/j.euf.2025.12.018
