Background: Urodynamics (UDS) is an investigative procedure used to evaluate bladder symptoms. The International Consultation on Incontinence (ICIQ) Urodynamics-Satisfaction questionnaire, developed in 2004, measured patient satisfaction with UDS. Aim: To develop new items assessing the perceived 'value' of UDS to the patient and to refine and validate the existing questionnaire items on patient 'satisfaction'. Methods: New items were developed, and the original questionnaire was updated using a modified Delphi process with clinical experts, followed by refinement through patient cognitive interviews. The resulting developmental questionnaire was pilot tested to assess its measurement properties. Results: The final 16-item ICIQ-S-UDS, comprising 11 'satisfaction' items, 5 'value' items and two free-text fields, was developed following feedback from an 11-member expert panel and four rounds of cognitive interviews with 12 patients. In the pilot phase, 98 completed the questionnaire and 57 completed the test-retest administration. Internal consistency was alpha = 0.69 for the 'satisfaction' items and alpha = 0.63 for the 'value' items. Exploratory factor analysis was not conducted due to low response variability and borderline Cronbach's alpha values. Test-retest reliability for most items demonstrated moderate agreement or higher (kappa, kappa >= 0.41), although 95 % confidence intervals were wide. Conclusion: The ICIQ-S-UDS can be recommended as a survey tool suitable for auditing and evaluating UDS clinical practice and patient care. However, further evidence from larger and more diverse patient samples are needed to support its use as a robust measurement scale.

Introduction Pelvic organ prolapse is a common condition and many women seek surgical treatment for prolapse symptoms. However, recurrence of prolapse after surgical treatment is common. A think tank was held at ICI-RS 2025 to discuss how the assessment and indifferent results from conservative and surgical management can be improved.Methods Data were collected and presented on identification of women at risk of prolapse recurrence after surgery, understanding patient goals and expectations, optimising lifestyle interventions, pelvic floor muscle training, pessary management, and surgical care. Discussions identified knowledge gaps and proposed research studies that could advance knowledge to improve treatment outcomes.Results There is insufficient information to understand the assessment of prolapse treatment outcomes; examination findings do not necessarily correlate with symptoms. Further research is needed to understand if patient-reported goal attainment is superior to patient-reported outcome measures, including measures of patient satisfaction. There is insufficient information on the value of lifestyle adjustments and pelvic floor muscle training as prehabilitation to improve surgical outcomes. The place of pessary management in an optimally integrated prolapse treatment pathway is unclear and the role that pessaries may have in anatomical modelling of prolapse is not fully understood. Further research into adjuncts to improve native tissue repair as alternatives to polypropylene mesh is needed to optimise surgical outcome.Conclusion Further research into understanding what represents treatment, cure, and optimising conservative and surgical treatments is of high priority to improve pelvic organ prolapse treatment outcomes. The utility of preoperative rehabilitation requires investigation. Developing an optimised pessary care pathway and continued surgical innovation are required to ensure progress in reducing prolapse symptom recurrence.

OBJECTIVE:To assess the measurement properties of the International Consultation on Incontinence-Perinatal Pelvic Health Self-Assessment Questionnaire (ICIQ-PPHSAQ) and to identify symptom subscales for scoring. DESIGN, SETTING AND POPULATION:Two cohorts of perinatal women (antenatal and postnatal) at nine NHS trusts in England completed ICIQ-PPHSAQ at baseline (16-19 weeks' gestation for the antenatal cohort and 6-9 weeks postnatal for the postnatal cohort) and at up to three further timepoints, with follow-up extending to 9 months postnatal. METHODS:Descriptive analyses and exploratory factor analyses (EFAs) identified symptom subscales from which subscale scores were calculated. Internal consistency was evaluated using Cronbach's alpha (α). Test-retest reliability was assessed using an interval of 1 week after baseline, using weighted Kappa (κ) for individual ordinal items and the intraclass correlation coefficient (ICC) for subscale scores. Construct validity and known-groups validity were assessed by comparison with the Patient Global Impression of Severity (PGI-S). Responsiveness was assessed by examining the mean differences between baseline and each timepoint. RESULTS:A total of 162 antenatal women who were 16-19 weeks gestation, and 173 women 6-9 weeks postnatal were recruited. Almost all the items performed acceptably in the test-retest analyses and completion rates were high in all the scored items (< 5% missing data). EFAs derived nine symptom subscales; seven of which had acceptable overall reliability indicators, except the vaginal symptom and vaginal changes subscales. Known-groups validity was demonstrated for all nine subscales, and six out of nine showed responsiveness to change (p < 0.05) over the study time-period. CONCLUSION:The study provides evidence supporting the validity and reliability of ICIQ-PPHSAQ, with responsiveness demonstrated across several domains. The instrument can be used to assess perinatal pelvic floor dysfunction risk factors and symptoms in English perinatal pelvic health services.

BACKGROUND:The artificial urinary sphincter (AUS) is the most common surgical procedure for persistent stress urinary incontinence (SUI) after prostate surgery, whereas the male sling is a newer alternative. OBJECTIVE:To compare the 24-mo outcomes of the sling versus the AUS. DESIGN, SETTINGS, AND PARTICIPANTS:This was an unblinded, noninferiority randomised controlled trial including men from 27 UK urological centres with bothersome urodynamic SUI after prostate surgery. INTERVENTION:Men were randomised to receive a transobturator sling (n = 190) or an AUS (n = 190). Randomisation was minimised by type of surgery (radical prostatectomy/transurethral resection of the prostate), previous radiotherapy for prostate cancer (yes/no), and centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was self-reported continence (a composite outcome derived from two items in the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF]) at 12 mo after randomisation, with a noninferiority margin of 15%, via postal questionnaire. The secondary outcomes were self-reported continence, further treatments, patient-reported measures and serious adverse events up to 24 mo. RESULTS AND LIMITATIONS:A total of 380 participants were included. In terms of continence, the sling was noninferior to the AUS at 24 mo (estimated absolute risk difference in the intention-to-treat analysis, -0.006; 95% confidence interval [CI], -0.092 to 0.080; noninferiority p = 0.001), indicating lower success in the sling group, but with a CI excluding the noninferiority margin. Incontinence symptom scores (ICIQ-UI SF) decreased from 16.1 and 16.4 at baseline to 7.9 and 7.1 in the sling and AUS groups, respectively. The mean difference was 1.4 (95% CI, 0.2-2.6; p = 0.024). Secondary outcomes favoured the AUS over the sling. By 24 mo, more men underwent further surgery after receiving a sling (n = 20, 11%) than after receiving an AUS (n = 4, 2%). CONCLUSIONS:The 24-mo results confirm that the sling is noninferior to the AUS. Symptoms and quality of life significantly improved in both groups. Overall, secondary and post hoc analyses favour the AUS. PATIENT SUMMARY:Continence levels and symptoms improve with both surgeries. Most men are satisfied with their surgery, despite not being completely dry. Almost all other results show that men who have an artificial urinary sphincter have better outcomes than those who have a sling. Trial registration International Randomised Controlled Trial Registry, ISRCTN49212975. This trial was registered on July 22, 2013, and participants were randomised between January 29, 2014, and December 28, 2017.

INTRODUCTION:There is an increasing recognition of the impact of ageing on pelvic floor health and the consequences in populations with rising proportions of women over the age of 65 years. A think tank was held at the ICI-RS 2024 to discuss the evidence to support the personalisation of women's pelvic floor health during the perinatal and perimenopausal period. METHODS:Data was collected and presented on the evidence to support the development of tools to personalise pelvic floor health care. Epidemiological, imaging, patient-reported outcomes, and evidence of tool development questionnaires were discussed. The current evidence and research gaps for potential intervention to prevent the pelvic floor disorders of pelvic organ prolapse, overactive bladder, urinary incontinence and faecal incontinence during the perinatal and perimenopasual time periods were discussed and identified. RESULTS:Epidemiological studies highlight that vaginal delivery and in particular operative vaginal delivery is the single biggest modifiable risk factor for the future development of pelvic floor dysfunction. The oestrogen depletion resulting from the perimenopause and menopause can lead to the development of Genitourinary syndrome of menopause (GSM) which is associated with the risk of developing pelvic floor dysfunction. Ultrasound is a useful technique for assessing the pelvic floor and has been used to assess bladder neck mobility, distensibility of the puborectalis muscle and the striated urethral sphincter volume antenatally with some studies reporting a correlation between these measurements and the need for Caesarean section and development of postpartum stress urinary incontinence. Further studies are needed to standardise these measurements. There are no patient reported outcome questionnaires validated for use in the perinatal and postmenopausal period. The UR- choice tool has been developed to counsel women on the risk of postpartum pelvic floor disorders occurring. However, further evaluation in larger numbers is required. CONCLUSION:There is significant interest in developing tools to counsel women on the risks of developing pelvic floor dysfunction post partum and after the menopause. Further evaluation of the UR-choice tool was considered a research priority. The timepoint of cervical screening for research into interventions such as pelvic floor health education, lifestyle optimisation and perimenopausal vaginal oestrogen supplementation was identified.

INTRODUCTION:Urological disposables, including catheters, stents, irrigation systems, and incontinence pads, are essential in functional urology but generate large volumes of nonbiodegradable waste. Intermittent self-catheterization is the gold standard for impaired bladder emptying, while disposable pads are a frequent first-line coping strategy for incontinence. Their widespread use presents a growing environmental challenge in healthcare. METHODS:At the 2025 International Consultation on Incontinence-Research Society meeting, a dedicated session examined sustainability in urological disposables. Three questions were addressed: (1) how to define and measure sustainability, (2) whether sustainable alternatives are clinically effective and safe compared to conventional products, and for which patient groups, and (3) whether disposables are cost-effective when environmental and health system costs are included. RESULTS:Sustainability assessment involves life cycle analysis, carbon and water footprint evaluation, material composition, and waste generation. Existing sustainability studies are limited, non-comparative, and methodologically inconsistent, often using variable definitions and incomplete life cycle boundaries. Reusable incontinence pads and catheters generally have a lower environmental impact than single-use designs. Clinical outcomes, including infection rates and safety, are largely comparable between reusable and single-use catheters, though user preference often favors single-use products for convenience. Economic evaluations rarely incorporate environmental impacts, but proposed methods include monetizing emissions, converting environmental effects into health outcomes, and applying multi-criteria decision-making to integrate sustainability alongside clinical and economic performance. CONCLUSION:Advancing sustainable continence care requires standardised metrics, integration of environmental costs into economic evaluations, and patient-centered product innovation, supported by collaboration between clinicians, policymakers, and industry.

AIMS:Management algorithms for Bladder Pain Syndrome (BPS) have remained stagnant over the past 20 years. Lack of high level evidence has hindered progress. Contributors to this have been the use of confusing and inconsistent terminology and failure to adequately phenotype participants entering clinical trials. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2025 a Think Tank addressed the question of "How can we make progress in the management of Bladder Pain Syndrome," focussing on the non-Hunner lesion group. METHODS:The Think Tank conducted a literature review and expert consensus meeting focusing on the current limitations in terminology and phenotyping, how we can improve identification of bladder-centric BPS, and how we can improve assessment of psychological comorbidity. RESULTS:Terminology needs to be standardised to enable more homogenous recruitment to clinical trials. Use of the term "interstitial cystitis" may be misleading, and the term is often inappropriately used. Classification based on the European Association of Urology guidelines should be favoured, using the term Primary Bladder Pain Syndrome. Participants entering clinical trials need to undergo thorough investigation to enable accurate phenotyping. The non-Hunner lesion BPS group need to be the focus of future research. Tools to aid identification of a bladder-centric phenotype (through biopsy and other techniques) need to be studied, including investigating the roles of inflammation, ischaemia and oxidative stress in this condition. A psychological assessment tool specific for BPS should be created to ensure earlier psychological intervention for those who would benefit most. CONCLUSIONS:The use of accurate terminology in describing this condition is the first step toward improving the quality of future research. The Think Tank overwhelmingly recommended that the term "Interstitial Cystitis" should not be used. Future studies should be focussed on understanding the BPS group, excluding those with Hunner lesion disease. Studying inflammation, ischaemia and oxidative stress will help to identify a bladder-centric phenotype, whereas improving our understanding of psychological mechanisms will help to direct psychological therapies more effectively.

AIMS:This report, from the International Consultation on Incontinence-Research Society, aims to evaluate the existing evidence and identify diagnostic and treatment gaps for Lower Urinary Tract Symptoms (LUTS) in post-menopausal women with Genitourinary Syndrome of Menopause (GSM). METHODS:An overview on the current literature, including pathophysiology, diagnosis and management of GSM associated LUTS, including incontinence, overactive bladder, underactive bladder and recurrent urinary tract infections (rUTIs). RESULTS:Significant gaps in the literature were identified. GSM is underdiagnosed and the interplay between hormonal changes in the postmenopausal period on LUTS remains poorly understood. Diagnostic methods for rUTIs lack sensitivity and the role of the urinary microbiome is emerging. Current treatments, including topical oestrogens and systemic hormone therapy, lack long-term efficacy data on LUTS. Evidence for regenerative medicine techniques remain limited by low-quality studies and short-term follow up. CONCLUSION:There is lack of high-quality evidence, which hinders the optimal management of LUTS in post-menopausal women with GSM. The panel proposes targeted research questions, focusing on the hormonal impact on the lower urinary tract, advancing diagnostics and robust clinical trials for existing and novel therapies, to bridge current gaps in the literature and improve patient care.

INTRODUCTION:Management of overactive bladder (OAB) has a stepwise approach in adults and children. This does not account for individual patient variations, which may explain suboptimal outcomes in many patients. Distinct OAB profiles, based on patient characteristics, symptoms, urodynamic findings and imaging have been discussed in Part 1. Personalized treatment and escalation pathways based on OAB profiling may lead to faster OAB symptom control and quality of life improvement, reduced cumulative side effects and costs, and improved treatment adherence. METHODS:A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping, and targeting therapy according to urgency type and other characteristics?" The group discussed the current literature on this topic and developed a list of research questions and strategies to help shape the future of the field. RESULTS:Tailored combination of antimuscarinics and/or beta3 agonists, with botulinum toxin A (BTX-A) and/or sacral nerve stimulation (SNS) was considered a high priority research topic. Profile-based individual treatment selection and delivery protocols for BTX-A and SNS are potential means to improve outcomes, as is the early escalation to BTX-A and SNS in the treatment pathway of both adults and children. Finally, phenotype-based treatment requires tight treatment outcome follow-up and possible adjustment (including re-phenotyping) for which tools need to be developed. CONCLUSION:Development and validation of a patient-based flow-chart to replace the current stepwise approach in OAB management will allow tailored treatment, aimed to improve therapeutic success, and to reduce side effects.

AIMS:While many patients with lower urinary tract symptoms (LUTS) improve by treating peripheral causes, a substantial proportion continue to experience symptoms despite apparently successful interventions. Central nervous system (CNS) mechanisms could potentially contribute to persisting symptoms after the initial peripheral cause has been treated. The aim of this paper is to explore how maladaptive CNS processes may underlie refractory LUTS and to consider the therapeutic and research implications. METHODS:The manuscript summarizes discussions from a proposal hosted at the 2025 International Consultation on Incontinence-Research Society (ICI-RS) meeting. Research priorities were formulated into consensus questions. RESULTS:Evidence indicates that central sensitization and neuroplasticity may sustain urgency, increased frequency, or pain even after resolution of peripheral triggers. Neuroimaging demonstrates structural and functional brain changes in bladder pain syndrome and spinal cord injury, while preclinical studies implicate neurotrophin and nitric oxide pathways in LUT dysfunction. Nerve stimulation, intravesical agents, and behavioral strategies can benefit selected patients, though with variable outcomes. Priority questions focus on causality versus consequence of CNS changes, the development of biomarkers for patient stratification, and the evaluation of novel therapeutic targets. CONCLUSIONS:Refractory LUTS potentially involve peripheral and/or central maladaptation. Advancing diagnosis and treatment will require improved tools to assess LUT-CNS interactions, refined translational models, and multidisciplinary strategies to enable individualized, mechanism-based therapies.

AIMS:To discuss the role of screening and treatment of affective symptoms, like anxiety and depression in patients with LUTD. A review of the literature regarding the bidirectional association and multidisciplinary approaches integrating psychometric assessments with personalized treatment plans to improve diagnostic accuracy and therapeutic outcomes of LUTD. METHODS:This review summarizes discussions and a narrative review of (recent) literature during an International Consultation on Incontinence-Research Society 2024 research proposal with respect to the role of screening for anxiety and depression, effect of mental health symptoms on treatment outcomes and future implications. RESULTS:Consensus recognized the importance to incorporate attention to anxiety and depression in relation to LUTD. The awareness of this association can lead to better outcomes. Future research projects are proposed to evaluate the bidirectional relationship. CONCLUSION:The relationship between affective symptoms and LUTD underscores the need for integrated treatment approaches that address both psychological and urological dimensions. Further research is required to identify specific patient subgroups that would benefit most from these interventions, to develop standardized screening tools, and to refine treatment protocols. Multidisciplinary care, incorporating psychological assessment and personalized treatment strategies, could enhance outcomes for LUTD patients.

INTRODUCTION:The management and interpretation of big data appears to be an increasingly attractive but challenging issue in functional urology. The International Continence Society (ICS) Global Urodynamics (UDS) Data Repository (GUDRep) project aims to record and analyse UDS data to share research and clinical information about UDS. OBJECTIVES:The aim of this Think Tank was to identify the main research questions and critical issues related to the GUDRep project. METHODS:This article reports and summarises the discussions on the GUDRep from the 2025 meeting of the International Consultation on Incontinence-Research Society (ICI-RS). RESULTS AND CONCLUSIONS:Several research questions on the GUDRep project need to be considered, including both issues/barriers in building the Repository and economic, clinical and research advantages which could potentially be obtained by the GUDRep itself.

INTRODUCTION:Artificial intelligence (AI) is poised to improve the diagnosis and management of lower urinary tract dysfunction (LUTD). Its effective deployment requires prioritization, regulatory oversight, rigorous validation, and clinician and patient engagement. METHODS:The Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 evaluated key considerations for successful AI implementation into LUTD clinical care. The topics included clinical triage framework, regulatory and legal principles, levels of evidence required for validation, and clinician and patient engagement to guide development. The group developed a narrative of the pressing matters related to AI implementation and a list of proposed research questions, which, when addressed, will help shape the future of the field. RESULTS:LUTD topics that should be prioritized for AI implementation include high-burden conditions with high unmet need such as neurogenic LUTD, bladder outlet obstruction, and overactive bladder. Regulatory frameworks such as the EU AI Act and the U.S. "Software as a Medical Device" and its associated guidance promote safety, transparency, and accountability. AI solutions should be as rigorously evaluated as other clinical devices or drug agents. Patient and clinician engagement are paramount to ensure innovation aligns with the pressing needs of patients and clinicians. CONCLUSIONS:AI's integration into LUTD care requires cross-disciplinary collaboration, prospective validation, and legal and ethical frameworks. AI must be developed and implemented with a strong focus on transparency, trust, and patient-centered care. CLINICAL TRIAL REGISTRATION:This study is not a clinical trial and thus does not warrant registration as such.

AIM:Metrics used to evaluate meaningful clinical outcomes have long been a matter of controversy, particularly where there is no defined objective cure and patient-reported metrics (PROMs) are utilised as objective measures of subjective phenomena. The ICI-RS 2025 think tank discussed the relative merits of objective and subjective outcomes in clinical trials. METHODS:A review of medical literature in four key areas; hard metrics versus PROMs assessment of Minimally Invasive Surgical Treatments for Bladder Outflow Obstruction, for Stress Urinary Incontinence, and their use in current registries and databases were debated. Limitations of trial design were highlighted and proposals for further reporting, steering groups and guidance panels suggested. RESULTS:It is yet to be fully understood how objective data and PROMs weigh bias and variability. Longitudinal study for objective and subjective metrics is required. Qualitative study with benchmarking may allow future studies to allow patients to set their own goals and develop more nuanced, patient-defined PROMs. Databases incorporating core metrics, specialist assessments and regression analysis may have utility to create composite algorithms into unified scoring systems. Artificial intelligence learning may be applied to large datasets. CONCLUSIONS:Both objective and subjective assessments have their limitations. A balanced approach, combining both may provide the most complete and accurate picture.

BACKGROUND AND OBJECTIVE:Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) study evaluated the diagnostic pathway for men considering surgery to treat LUTS and reported the outcomes at 18 mo. This long-term follow-up study reports the symptoms and rates of prostate surgery at 5 yr. METHODS:UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at 5 yr after randomisation (October 2019-December 2021). The primary outcome was the patient-reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from the National Health Service (NHS) England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised. KEY FINDINGS AND LIMITATIONS:At 5 yr, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed the questionnaires, with routine data obtained for 801/820 (97.7%). The mean IPSS at 5 yr did not differ between randomised groups (adjusted difference 0.41, 95% confidence interval -1.10, 1.93), nor did the rates of surgery (0.96 [0.71, 1.28]). Urinary and sexual symptoms also showed no differences between the randomised groups. The main limitation is the reduced numbers of men in follow-up. In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by the participants, advised by their clinicians. CONCLUSIONS AND CLINICAL IMPLICATIONS:Five-year follow-up does not support the routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery. Urodynamics should be used selectively in the evaluation of uncomplicated LUTS.

BACKGROUND:Nocturia is a prevalent condition with systematic etiologies which require multidisciplinary collaborations during diagnosis and management. Here we evaluate current evidence and present unresolved research questions regarding the three key pathophysiological domains of nocturia with respect to a conceptual brain-kidney-bladder axis, namely sleep enhancement, extra-renal water reabsorption and circadian regulation of bladder tissue. METHODS:A Think Tank was convened at the 12th International Consultation on Incontinence Research Society meeting in June 2025, looking at novel therapeutic targets for nocturia. This article synthesizes key deliberations from this meeting session. RESULTS:The discussion was mainly focused on idiopathic nocturia with an overactive bladder symptom complex or nocturnal polyuria. Firstly, medications and conservative nondrug measures targeting sleep that could potentially improve nocturia were considered. Secondly, investigation of water reabsorption mechanisms within the bladder and the role of small molecule vasopressin receptor type-2 agonists were examined that may provide novel therapeutic options to rectify nocturnal polyuria. Finally, to address circadian misalignments, organ specific chronotherapies, based on abnormal circadian features of bladder tissues that can be curative for nocturia, were discussed. CONCLUSIONS:The evidence indicates that promising therapeutic modalities targeting the regulation of sleep-wake cycles, intravesical water transport mechanisms, and circadian patterns of detrusor activity may offer alternative strategies for managing nocturnal polyuria. However, further mechanistic investigations and randomized controlled trials are required to advance these approaches toward clinical translation.

AIMS:To complete the psychometric validation and scale derivation of the International Consultation on Incontinence Questionnaire-Underactive Bladder (ICIQ-UAB). METHODS:The developmental ICIQ-UAB was administered within a Phase II randomised controlled trial of a drug for the treatment of underactive bladder at baseline and follow-up 4 weeks after the start of trial medication treatment. Descriptive analyses and exploratory factor analyses (EFAs) informed the derivation of scored domains for symptoms, health-related quality of life (HRQoL), and associated bother items. The reliability was assessed by Cronbach's α, while validity was assessed via the correlation with other concurrently administered PROMs at baseline. Responsiveness was evaluated using the change in mean scores from baseline to follow-up. RESULTS:A total of 132 male and female patients with the symptomatic and urodynamic characteristics of detrusor underactivity were enrolled in the analysis. Descriptive analyses and EFAs informed scored domains for 11 symptom items with associated bother, and 7 HRQoL items with associated bother. A further 8 unscored symptom items and one overall HRQL item were retained for their clinical utility. Sensitivity of the ICIQ-UAB to the severity of the condition was supported (known groups validity), and correlations with concurrent PROMs were as expected, showing evidence of construct validity. All domains demonstrated reliability (Cronbach's α ≥ 0.88). Limited evidence for responsiveness was found, which was likely due to insufficient efficacy of trial medication treatment over administration time-points. CONCLUSIONS:The two scored domains and associated bother for the ICIQ-UAB have been shown to be reliable, valid and sensitive to the severity of the condition. The instrument can be recommended to researchers and clinicians for the comprehensive assessment of symptoms and their impact on HRQoL on patients with suspected UAB.

AIMS:To discuss the relationships between mental health problems (MHP) and lower urinary tract symptoms (LUTS). To propose an assessment plan for identifying MHP in patients presenting with LUTS. METHODS:This review is the outcome of a global multi-disciplinary think tank at the International Consultation on Incontinence (ICI-RS 2025) meeting held in June 2025 in Bristol, United Kingdom that examined the broad issue of mental health and LUTS. The relationship of MHP and LUTS in adults and children, and the possible underlying mechanisms, is presented. RESULTS:Robust evidence was noted for an association between MHP and LUTS, including storage symptoms, voiding symptoms, and bladder pain. However, the underlying mechanisms that underpin this relationship remain unclear. Clinical markers that might indicate MHP and screening tools for assessment by clinicians involved with LUTS care, are discussed. Recommendations are made with regard to key areas for future research. CONCLUSIONS:There is a consensus on the existence of a relationship between mental health problems and lower urinary tract symptoms. A better understanding of the nature of this relationship, the mechanisms that underlie it, and the best methods to assess it, is crucial to improving clinical care.