Invasive urodynamic studies (UDS) are considered the gold standard for evaluating lower urinary tract function in patients presenting with lower urinary tract symptoms (LUTS). However, there may be discordance between subjective symptoms and objective urodynamic findings. This study aimed to assess the correlation between patients' symptoms, standardized questionnaires, and invasive urodynamic findings in a cohort of patients who underwent UDS for LUTS.

Patients who underwent invasive urodynamic investigation for LUTS at a tertiary referral centre between January 2022 and July 2024 were retrospectively evaluated. All patients underwent detailed medical history-taking, physical examination, and symptom assessment. Prior to urodynamic studies, patients completed symptom-specific validated questionnaires, including ICIQ-FLUTS (for females), ICIQ-MLUTS (for males), Neurogenic Bladder Symptom Score (for neurogenic bladder), and the Incontinence Impact Questionnaire (IIQ) when applicable. Patients were classified into three groups based on their predominant symptoms: storage, voiding, and post-micturition symptoms, both via clinical evaluation and questionnaire results.
All urodynamic studies were performed in accordance with ICS standards and included video-assisted cystometry and pressure-flow studies. Correlations between symptom types, questionnaire scores, and urodynamic diagnoses were analyzed.

Ninety-nine patients were included: 78 females (78.7%) and 21 males (21.3%). Thirty patients (30.3%) had neurogenic bladder. The median age was 54.5 years (range: 18–82).

Storage symptoms were reported by 76 patients (76.8%), voiding symptoms by 28 (28.3%), and post-void symptoms by 26 (26.3%), regardless of whether these were isolated or part of a mixed presentation. Based on patient-reported outcomes, 6 patients (6.1%) had isolated voiding symptoms, 40 (40.4%) had isolated storage symptoms, 6 (6.1%) had isolated post-void symptoms, and 47 (47.5%) had mixed symptoms involving more than one phase.

Mean ICIQ scores in females were: storage 8.04 ± 3.22, incontinence 8.76 ± 6.23, and voiding 4.89 ± 3.54. In males, corresponding scores were: storage 10.26 ± 4.07, incontinence 7.05 ± 5.61, and voiding 4.16 ± 1.80. These findings suggest that storage symptoms were more pronounced in males, while incontinence scores were higher in females.

Among patients with storage symptoms, detrusor overactivity (DO) was found in 33 (43.4%), underactive bladder in 21 (27.6%), and bladder outlet obstruction (BOO) in 14 (18.4%). Of 53 patients with voiding or mixed symptoms, 16 (30.2%) had BOO and 22 (41.5%) had underactive bladder on urodynamics.

Urodynamic storage-phase abnormalities correlated well with reported storage symptoms across both genders. However, only 49.3% (34/69) of female patients with voiding-phase dysfunction reported matching symptoms, compared to 88.9% (16/18) of male patients. This gender discrepancy suggests symptom under-reporting or misinterpretation of voiding dysfunction in females.

Our findings emphasize the multifactorial nature of LUTS and the limited predictive value of symptoms or questionnaires alone. While storage symptoms often aligned with detrusor overactivity, many patients exhibited overlapping pathologies, including underactive bladder and bladder outlet obstruction. Gender differences were notable—voiding symptoms correlated more accurately with urodynamic findings in males than in females.These results underscore the importance of integrating clinical evaluation, PROMs, and urodynamic testing to achieve accurate diagnosis and guide individualized treatment in patients with complex or mixed urinary symptoms.

Lower urinary tract symptoms are not reliable witness. The correlation between symptoms, validated questionnaires, and urodynamic findings varies by symptom type and gender. Although symptom-based assessment remains essential, our findings emphasize the importance of interpreting UDS results within the broader clinical context. A comprehensive approach combining clinical findings, symptom questionnaires, and urodynamics should be employed for individualized diagnosis and treatment planning.