Beyond Obstruction: Detrusor Underactivity and the Role of Urodynamics Before Bladder Outlet Procedures

Abstract Purpose of Review This review evaluates the role of preoperative urodynamic studies (UDS) for characterizing detrusor function in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). It aims to clarify how urodynamic parameters predict outcomes across surgical modalities, from minimally invasive therapies to enucleation procedures, and to assess their utility in guiding clinical decision-making. Recent Findings Evidence suggests that detrusor underactivity (DU) is associated with more variable and less robust short-term outcomes following outlet procedures; however, many patients still achieve meaningful improvements, including recovery of spontaneous voiding. While UDS remains the gold standard for diagnosing DU, its routine use preoperatively is debated due to invasiveness, limited standardization, and uncertain impact on management. Emerging imaging and ambulatory technologies may enhance diagnostic precision preoperatively. Summary DU should not preclude surgical intervention for BPH, though it necessitates careful counseling. UDS may be most valuable in select, high-risk populations.