Abstract: We included two trials, but data were available for only 339 men in one trial, of whom 188 underwent invasive urodynamic studies. We found evidence of risk of bias, such as lack of outcome information for 24 men in one arm of the trial. Statistically significant evidence suggests that the tests did change clinical decision making. Men in the invasive urodynamics arm were more likely to have their management changed than men in the control arm (proportion with change in management 24/188 (13%) vs 0/151 (0%), risk ratio (RR) 39.41, 95% confidence interval (CI) 2.42 to 642.74). However, the quality of the evidence was low. Low-quality evidence indicates that men in the invasive urodynamics group were less likely to undergo surgery as treatment for voiding LUTS (164/188 (87%) vs 151/151 (100%), RR 0.87, 95% CI 0.83 to 0.92). Investigators observed no difference in urine flow rates before and after surgery for LUTS (mean percentage increase in urine flow rate, 140% in invasive urodynamic group vs 149% in immediate surgery group, P value = 0.13). Similarly, they found no differences between groups with regards to International Prostate Symptom Score (IPSS) (mean percentage decrease in IPSS score, 58% in invasive urodynamics group vs 59% in immediate surgery group, P value = 0.22). No evidence was available to demonstrate whether differences in management equated to improved health outcomes, such as relief of symptoms of voiding dysfunction or improved quality of life. No evidence from randomised trials revealed the adverse effects associated with invasive urodynamic studies. Although invasive urodynamic testing did change clinical decision making, we found no evidence to demonstrate whether this led to reduced symptoms of voiding dysfunction after treatment. Larger definitive trials of better quality are needed, in which men are randomly allocated to management based on invasive urodynamic findings or to management based on findings obtained by other diagnostic means. This research will show whether performance of invasive urodynamics results in reduced symptoms of voiding dysfunction after treatment.

Plain-language summary: We found two trials, which included around 350 men, although information was available for only 339 men in one trial. Evidence was not sufficient to show whether invasive urodynamic tests led to better patient outcomes. Some evidence suggests that these tests did alter management decisions, resulting in fewer men undergoing surgery. No evidence indicates whether this change in management led to fewer symptoms in men after treatment, and it is not known whether patients reported a better quality of life. No information obtained from the included trials reveals how common side effects were in those undergoing invasive urodynamic testing. Not enough information from trials is available regarding the benefits of invasive urodynamic testing for men with voiding dysfunction. More research is needed in which people are randomly assigned to treatment decisions based on their symptoms, physical examination findings and results of non-invasive tests alone, or based on the extra information provided by invasive urodynamic tests. Future studies will help healthcare providers determine whether patients benefit from these extra tests, and whether the tests provide good value for healthcare systems.