Editorial Comment.

In recent years an increasing number of noninvasive tests have been described to replace the pressure flow study in diagnosing bladder outlet obstruction in men with LUTS, avoiding the burden and morbidity associated with invasive urodynamics. As reported in a systematic review, several noninvasive tests demonstrated high specificity and sensitivity in diagnosing bladder outlet obstruction in men. However, the available evidence is limited by heterogeneity. Even if several noninvasive assessments of bladder outlet obstruction have shown promising results, invasive urodynamics remain the gold standard. The authors evaluated voiding characteristics of 50,680 men with LUTS who underwent a UroCuff test, a noninvasive PFS. The aim of the study was to document the deterioration of urodynamic bladder function that occurs with age. The most relevant evidence is that flow rates, voided volumes, flow rate efficiencies and post-void residual get worse with advancing age as well as the bladder efficiency with a decompensation phase starting from age 62. The main limitation of the study is the lack of data about diagnosis, symptoms and treatment outcomes. Nevertheless, the results cannot be extended to a general population considering that study included exclusively men with LUTS enrolled in urological outpatient visits. Further studies comparing UroCuff with validated predictive models as a control tool are needed to better define the clinical efficacy of this new test.