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.
Marcus J. Drake,1 Valerio Iacovelli,2 Francisco Cruz,3 Dean Elterman,4 Andrew Gammie,5 Chris Harding,6,7 Hashim Hashim,5 Thomas M. Kessler,8 Ruth Kirschner-Hermanns,9,10 Gommert van Koeveringe,11 Scott MacDiarmid,12,13 Sachin Malde,14 Cosimo de Nunzio,15 Véronique Phé,16 Eric Rovner,17 Eskinder Solomon,14 Tufan Tarcan,18,19 Kari A.O. Tikkinen,20-22 Stefan de Wachter,23,24 Enrico Finazzi-Agro,2
- Department of Surgery and Cancer, Imperial College, London, UK
- Department of Surgical Sciences, University of Rome Tor Vergata and Policlinico Tor Vergata University Hospital, Rome, Italy
- Hospital São João and Rise Health Research Institute, University of Porto Faculty of Medicine, Porto, Portugal
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University Clinic Bonn, Bonn, Germany
- Department of Neuro-Urology, Johanniter Neurologic Rehabilitation Center, Bonn, Germany
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
- Alliance Urology Specialists, Greensboro, NC, USA
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
- Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- Ospedale Sant’Andrea, Sapienza University of Rome, Rome, Italy
- Department of Urology, Tenon Academic Hospital, AP-HP, Sorbonne University, Paris, France
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Urology, Koç University School of Medicine, Istanbul, Türkiye
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, Päijät Häme Central Hospital, Lahti, Finland
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Urology, Antwerp University Hospital, Antwerp, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium