Impact of Urodynamic Parameters on Treatment Decision‐Making in Men Under 50 With Treatment‐Resistant Chronic Lower Urinary Tract Symptoms

BACKGROUND: Lower urinary tract symptoms (LUTS) in young men are heterogeneous, and symptom-based management often fails to identify the underlying dysfunction, particularly in treatment-resistant cases. OBJECTIVE: To assess the impact of multichannel urodynamic studies (UDS) on clinical management decisions and identify urodynamic predictors of treatment modification in men under 50 years with chronic LUTS. METHODS: In this prospective cross-sectional study, men aged 18-49 years with LUTS persisting for ≥ 6 months despite prior guideline-concordant therapy underwent standardized multichannel UDS. Clinical management plans were recorded immediately before and after UDS interpretation. Management changes were classified as major or minor. Associations between urodynamic diagnoses, objective parameters, symptom scores, and management changes were evaluated using multivariable logistic regression. RESULTS: A total of 723 men (mean age 38.4 ± 8.9 years) were included. Overall, 63.3% experienced a UDS-guided management change, including 41.6% with major treatment modifications. Major changes occurred predominantly in patients with abnormal urodynamic findings, especially underactive detrusor, low compliance, bladder neck dysfunction, and combined abnormalities, while no major changes occurred in patients with normal UDS. Bladder compliance, bladder contractility index, bladder outlet obstruction index, and urodynamic diagnosis were the strongest predictors of management change (AUC = 0.954). Symptom scores and post-void residual alone were poor discriminators of underlying pathology. CONCLUSIONS: Urodynamic studies play a pivotal role in guiding individualized management in young men with treatment-resistant LUTS, providing objective information that meaningfully alters clinical decision-making.