Overactive bladder (OAB) is a highly prevalent lower urinary tract condition linked to impaired quality of life, while detrusor overactivity (DO) represents an objective urodynamic subtype of OAB. Since urodynamic study (UDS) is invasive, costly, and not universally available, we hypothesized that key symptoms measured by the International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms Modules (ICIQ‑LUTS) are strongly associated with DO. This study aimed to examine the relationship between OAB‑related symptoms and DO, identify independent predictive factors, and develop a simple, non‑invasive, questionnaire‑based model to stratify DO risk in patients with OAB symptoms, especially for resource‑limited clinical settings.

We conducted a retrospective cross‑sectional study at a tertiary urological center, including 6,509 adult patients who underwent UDS for lower urinary tract symptoms between 2009 and 2017. Patients with neurogenic disorders, dementia, active urinary tract infection, urethral stricture, bladder stones, or severely incomplete data were excluded. Demographic characteristics, ICIQ‑LUTS symptom scores (0–4 Likert scale), and urodynamic results were collected. Variables were selected using LASSO regression. Multivariable logistic regression was applied to determine independent predictors and construct prediction models. Model performance was evaluated using AUC, sensitivity, specificity, positive/negative predictive value, and Youden index.

The study cohort included 60.2% female patients with a mean age of 57.3 years, and 54% were diagnosed with DO via UDS. The overall multivariable model showed moderate discriminatory ability with an AUC of 0.702 (95% CI 0.689–0.716). After adjustment, urgency (OR = 1.8) and urgency urinary incontinence (UUI; OR = 2.6) were the most powerful independent positive predictors of DO, with a weaker association observed for smoking. Sex was a significant negative covariate (OR = 0.4). Sex‑stratified analysis revealed distinct predictive patterns: age, urgency, and UUI were major factors in males, whereas smoking and nocturia were independently associated with DO in females. Regarding model performance, UUI alone achieved the highest Youden index and positive predictive value (0.75) in males. In the overall cohort and females, the combined UUI + urgency score (cutoff = 5) provided better stratification than single items. Adding frequency or nocturia did not meaningfully improve model accuracy. All models presented gradual DO risk gradients but only moderate sensitivity and specificity, with the highest Youden index approximately 0.3 in males and 0.2 in females. Notably, 12.2% of patients with DO did not report urgency as a primary complaint.

These findings confirm that selected ICIQ‑LUTS items, particularly urgency and UUI, can moderately predict DO and enable clinically useful risk stratification. The observed sex differences suggest distinct pathophysiological or symptomatic profiles: UUI is the dominant predictor in men, while smoking and nocturia contribute additional predictive value in women. The moderate predictive accuracy reflects inherent discrepancies between subjective symptoms and objective urodynamic findings, partly due to catheter‑induced irritation or variable urgency perception. Although the models cannot replace invasive UDS for a definitive diagnosis, they offer a practical screening tool for initial evaluation. The limited added value of frequency and nocturia implies these symptoms are less reliable for DO prediction, possibly due to behavioral adaptations such as fluid adjustment in OAB patients.

A simplified symptom score based on ICIQ‑LUTS urgency and UUI items provides moderate DO risk stratification with clear sex‑specific patterns. This non‑invasive approach supports initial screening and personalized clinical decision‑making in primary care and resource‑constrained settings, reducing unnecessary invasive urodynamic testing.