Women With Overactive Bladder Can Avoid Urodynamics Testing

TOPLINE:

Urodynamics plus comprehensive clinical assessment (CCA) showed no superiority over CCA alone in treating women with refractory overactive bladder symptoms. CCA for female incontinence offered equally valuable insights for guiding treatment without the need for invasive procedures.

METHODOLOGY:

• Researchers conducted the FUTURE trial across 63 hospitals in the United Kingdom to compare the clinical effectiveness and cost-effectiveness of urodynamics plus CCA vs CCA alone in treating women with refractory overactive bladder symptoms.
• A total of 1099 women aged 18 years or older with refractory overactive bladder or urgency-predominant mixed urinary incontinence who did not respond to conservative management were randomly assigned to either the urodynamics plus CCA group (n = 550) or the CCA-only group (n = 549); patients were followed up for up to 24 months.
• All participants underwent a non-invasive CCA, which included assessment of medical history, a physical examination, completion of a 3-day bladder diary, and a bladder scan. The urodynamics group underwent cystometry and uroflowmetry with or without pressure flow studies.
• The primary clinical outcome was participant-reported success (defined as “very much improved” or “much improved”) at the final follow-up, measured using the Patient Global Impression of Improvement at 15 months after randomisation.

TAKEAWAY:

• At the final follow-up, participant-reported success rates of women who underwent urodynamics plus CCA were not superior to those of women who underwent CCA alone (23.6% vs 22.7%; adjusted odds ratio, 1.12; P = .60).
• Among participants who received botulinum toxin A (BoNT-A), success rates at 2 months post-treatment were similar for the urodynamics plus CCA group (63.8%) and the CCA-only group (60.0%).
• At earlier timepoints (3 and 6 months), notable differences in participant-reported success rates were observed between the groups, with women receiving CCA alone being more likely to start treatment without waiting for the urodynamics test.
• The occurrence of serious adverse events was low and comparable between the groups.

IN PRACTICE:

“The FUTURE trial is an important reminder for clinicians of all specialties to think critically about the diagnostic evaluations ordered for patient management. Urodynamics should not be a reflexive step before pursuing invasive treatments, but rather viewed as a tool to facilitate individualised care for patients,” experts wrote in an accompanying editorial.

SOURCE:

This study was led by Mohamed Abdel-Fattah, MD, Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom. It was published online on March 22, 2025, in The Lancet.

LIMITATIONS:

The majority of participants underwent BoNT-A treatment, reflecting UK practices, which may have limited the applicability of the results to countries with different treatment protocols. Follow-up was limited to 15-24 months, resulting in a lack of information on whether women in the CCA-only group would eventually require urodynamics. The impact of the COVID-19 pandemic resulted in several participants not receiving the intervention or treatments during the initial 15-month follow-up period; however, an additional follow-up timepoint was arranged at 24 months for those who experienced these delays.

DISCLOSURES:

This study was funded by the UK National Institute for Health and Care Research Health Technology Assessment Programme. Some authors reported receiving grants, speaker fees, consulting fees, honoraria, and travel sponsorship and having other ties with pharmaceutical companies and certain institutions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.