The role of urodynamics in overactive bladder: a critical in-depth analysis of the FUTURE study

The FUTURE study, a large randomised controlled trial in women with refractory overactive bladder, concluded that urodynamics does not improve outcomes when added to clinical assessment and is not cost-effective. These findings have been presented as justification for abandoning urodynamics in this large and heterogeneous patient population. In this paper, we undertake a detailed appraisal of the FUTURE study, examining its overarching research premise, the design and methodology it employed to evaluate the clinical utility of urodynamics and the way in which its findings were reported and interpreted by the authors. We conclude that significant conceptual and methodological limitations undermine the validity of the study and the reliability and generalisability of the data. Consequently, changes in clinical practice are not justified on the basis of the FUTURE study.