A NEW UK-based clinical trial has found that urodynamic testing, a diagnostic tool commonly used before invasive treatments for overactive bladder, may not improve outcomes or represent good value for money when compared to standard clinical assessment alone.
Overactive bladder, a condition marked by symptoms such as urinary urgency, frequency, and nocturia, affects a significant proportion of adult women in the UK. When conservative treatments fail, as they do in 25–40% of cases, current guidelines recommend urodynamics to confirm the diagnosis of detrusor overactivity before proceeding to more invasive interventions like botulinum toxin injection-A or sacral neuromodulation.
The study, which involved 1099 women from 63 UK hospitals, randomly assigned participants to receive either urodynamics plus clinical assessment or clinical assessment alone. After 15 months, patient-reported improvement rates were nearly identical between the two groups, 23.6% in the urodynamics arm and 22.7% in the assessment-only arm. The difference was not statistically significant. Moreover, serious adverse events were rare and occurred at similar rates in both groups.
From an economic perspective, urodynamics added £463 in cost and yielded a modest 0.011 additional quality-adjusted life-years (QALYs), resulting in an incremental cost-effectiveness ratio of £42,643 per QALY gained. This figure exceeds the commonly accepted NHS threshold of £20,000 per QALY, suggesting that urodynamics is unlikely to be cost-effective. The probability of cost-effectiveness fell even further when extrapolated over a patient’s lifetime.
Although the study had some limitations, including the short follow-up period and the high rate of botulinum toxin use which limited secondary analyses, the findings question the routine use of urodynamics in managing refractory overactive bladder. Researchers conclude that longer-term follow-up is necessary, but at present, urodynamics appears to offer no clear clinical benefit and does not represent good value for the NHS.
Reference
Abdel-Fattah M et al. Invasive urodynamic investigations in the management of women with refractory overactive bladder symptoms: FUTURE, a superiority RCT and economic evaluation. Health Technol Assess. 2025;29(27):1-139.
