A Narrative Review of Urodynamics in Men With Lower Urinary Tract Symptoms: Diagnostic Test, Treatment-Decision Tool, or Prognostic Marker?

Lower urinary tract symptoms (LUTS) in men are common, multifactorial, and frequently difficult to attribute to a single underlying mechanism. Although invasive urodynamic studies (UDS), particularly pressure-flow studies, have long been considered the reference standard for physiological characterization of bladder outlet obstruction (BOO), detrusor underactivity (DU), and mixed dysfunction, their routine use has come under increasing scrutiny in recent years. This narrative review evaluates the contemporary role of UDS in male LUTS as a diagnostic tool, treatment-decision aid, and prognostic marker. It also examines non-invasive alternatives, current controversies, and future directions. Current practice increasingly supports moving away from routine preoperative UDS in men with uncomplicated LUTS toward a more selective, indication-driven approach. UDS continues to offer important value in situations with greater diagnostic uncertainty, including young men with refractory symptoms, suspected DU, persistent symptoms after previous intervention, and neurogenic lower urinary tract dysfunction, where accurate assessment of storage pressures, compliance, and sphincter coordination may be important for upper urinary tract protection. Pressure-flow studies remain uniquely capable of differentiating BOO from impaired detrusor contractility and identifying mixed dysfunction when non-invasive tests are inconclusive. Non-invasive tools such as uroflowmetry, post-void residual measurement, ultrasound-derived parameters, and clinical prediction models may serve as useful triage instruments within a stepwise diagnostic pathway, but they have not yet replaced invasive UDS in complex or high-risk patients. Technical quality, standardization, and interobserver variability continue to represent important limitations of urodynamic testing. Contemporary practice, therefore, favors a selective approach to UDS in male LUTS, with its greatest clinical utility lying in the resolution of meaningful diagnostic uncertainty and support of individualized, phenotype-driven management rather than broad routine application.