AIMS To evaluate whether the treatment based on urodynamics (UDS) leads to better treatment response compared to where the treatment is based on symptoms alone. STUDY DESIGN, MATERIALS AND METHODS: All patients referred with lower urinary tract symptoms (LUTS) were offered the opportunity to participate in this patient preference trial. Patients were asked to complete a Kings Health Questionnaire (KHQ) and a 3-day bladder diary. The patients were then offered treatment based on their preference for conservative therapy based on either symptoms alone or with additional UDS or randomization to the same two alternatives, if they had no preference. The primary outcomes studied were improvement in KHQ and reduction in Incontinence Episode Frequency (IEF) at 6 months. Logistic regression analysis was done to evaluate the effect of choice of treatment and effect of incontinence on KHQ. RESULTS There was no statistically significant difference between the KHQ scores pre and post UDS in patient preference or randomized groups. Follow up attendance rates were significantly better in those who chose to undergo urodynamics when compared to those who chose conservative treatment. CONCLUSIONS This study suggests although UDS does not improve IEF, it may have utility in patient choice and subsequent compliance. Another relevant finding was the previously unreported high uptake of UDS by women when given the choice of whether to undergo UDS first or have treatment based on symptoms alone.