<b><i>Introduction:</i></b> The routine use of urodynamic studies (UDS) has been questioned. Additionally, the material and personnel costs are poorly remunerated. We aimed to analyse the UDS utilization in Germany. <b><i>Methods:</i></b> We analysed UDS performed by hospitals based on quality reports from 2013 to 2019. A representative sample of 4 million insured persons was used to estimate outpatient UDS utilization from 2013 to 2018. <b><i>Results:</i></b> There was an overall decrease of 14% in UDS in Germany from 2013 to 2018 (60,980 to 52,319; <i>p</i> = 0.003). In the outpatient sector, there was a slight non-continuous drop of 11% from 34,551 to 30,652 from 2013 to 2018 (<i>p</i> = 0.06). UDS utilization in hospitals decreased by 26% from 26,429 in 2013 to 19,453 in 2019 (<i>p</i> = 0.004). University hospitals showed a smaller decrease (3,007 to 2,685; <i>p</i> = 0.02). In urology, the number of UDS (11,758 to 6,409; <i>p</i> < 0.001) and the number of performing departments (328 to 263 clinics; <i>p</i> < 0.001) decreased. Gynaecological departments also showed a decrease in UDS (1,861 to 866; <i>p</i> < 0.001) and performing departments (159 to 68; <i>p</i> < 0.001). However, in paediatrics, there was an increase in UDS (1,564 to 2,192; <i>p</i> = 0.02). By age, the number of children remained constant (1,371 to 1,252; <i>p</i> = 0.2), but there was a strong decrease seen in 60- to 79-year-olds (9,792 to 5,564; <i>p</i> < 0.001). <b><i>Conclusion:</i></b> UDS appear to be less important in the indication for surgery. Despite high resource expenditure and low remuneration, the decrease in urodynamics in the outpatient sector is less pronounced, indicating a trend to perform UDS in an outpatient setting.
