For women suffering from ongoing urinary incontinence, new research suggests they may be able to skip invasive bladder pressure tests, as non-invasive assessments can provide equally effective guidance for treatment. This groundbreaking study, led by researchers at the University of Aberdeen, demonstrates that a range of non-invasive methods can help guide treatment decisions just as well as traditional invasive testing.
The results of the FUTURE Trial were presented at the European Association of Urology (EAU) Congress in Madrid on March 22, 2025, and were published in The Lancet. The study marks the world’s first randomised controlled trial to examine the clinical and cost-effectiveness of invasive urodynamics testing for women with overactive bladder and urge urinary incontinence that do not respond to initial treatments.
Over the past 40 years, invasive urodynamics testing has been a standard procedure for assessing bladder function in women whose incontinence does not improve with first-line treatments like pelvic floor exercises, bladder retraining, and medications. The test involves inserting a catheter into the bladder to fill it with water and measuring bladder pressures with additional catheters inserted into the vagina or rectum. Though effective in identifying whether the condition is caused by an overactive detrusor muscle, the test is often uncomfortable and invasive, leading many women to seek alternatives.
Rather than resorting to invasive testing, a Comprehensive Clinical Assessment (CCA) can provide a detailed picture of a patient’s condition. CCA includes a medical questionnaire, physical examination, bladder diary, a “cough test” to assess stress incontinence, urinalysis, and a post-void residual volume test to check the amount of urine left in the bladder. These non-invasive methods can help doctors design an effective treatment plan without the discomfort of invasive procedures.
The FUTURE Trial involved 1,099 women from 63 UK hospitals. Participants had overactive bladder or urinary incontinence, predominantly characterized by a sudden urgency to urinate, and had not responded to first-line treatments. They were randomly assigned to one of two groups: one group underwent invasive urodynamics testing followed by CCA, while the other group received only CCA.
Over a 15–24-month follow-up period, both groups were asked to report on their treatment outcomes. The study found no significant difference in the improvement of symptoms between the two groups. In fact, 23.6% of women in the urodynamics group reported that their symptoms were “very much” or “much” improved, while 22.7% of women in the CCA-only group reported similar results. Interestingly, women who underwent only CCA reported earlier improvements in their symptoms.
The trial also revealed that 13% of women who underwent invasive urodynamics had their diagnosis changed to urodynamic stress incontinence, which led to a change in their treatment plan. However, this did not result in better patient-reported success rates or improved quality of life compared to the CCA-only group.
The researchers also conducted an economic evaluation, concluding that invasive urodynamics testing is not cost-effective for this group of women, particularly when compared to the UK’s National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20,000 per additional year of good health.
Professor Mohamed Abdel-Fattah, lead researcher and Director of the Aberdeen Centre for Women’s Health Research at the University of Aberdeen, emphasized that the findings indicate that comprehensive clinical assessments alone are sufficient for designing successful treatment plans in most cases. “Women no longer have to undergo invasive procedures to achieve improvements in their symptoms and quality of life,” he said.
While the findings of the FUTURE Trial provide compelling evidence that invasive urodynamics testing can often be avoided, Professor Benoit Peyronnet from the Rennes University Department of Urology in France cautioned that in some clinical settings, particularly in busy practices, urodynamics tests may still play a crucial role. He pointed out that the trial focused on patient-reported outcomes over a two-year period and suggested that longer-term studies would be valuable for further understanding the benefits of non-invasive assessments.
Currently, the FUTURE Trial is underway for a five-year follow-up, which will assess the long-term outcomes and cost-effectiveness of urodynamics testing. These future results will be crucial in further refining treatment protocols for urinary incontinence and ensuring that women receive the most effective and least invasive care possible.
This research provides a crucial step toward improving the treatment of urinary incontinence in women by offering less invasive alternatives to urodynamics testing. The findings suggest that comprehensive clinical assessments can often provide sufficient information for designing effective treatment plans, thus sparing many women from the discomfort and inconvenience of invasive procedures. As further research is conducted, it may lead to even more tailored and effective care for those suffering from urinary incontinence.
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