Objectives: There is conflicting evidence regarding the indications of urodynamic studies (UDS) and various guidelines. American urogynecologic Society (AUGS), National Instititute of Health and Care Excellence (NICE), and WHO provide variant indications for UDS testing. For developing countries, there are no data to support the usefulness of UDS. Considering the cost, invasiveness, and expertise required for UDS, we planned to review UDS performed at Aga Khan University and Hospital (AKUH) from 2007 to 2014. Our purpose of study was to derive important conclusive messages as a guideline for future practices. Study design: This is a cross-sectional retrospective review of 500 patients undergoing UDS from 2007 to 2014. Results: Comparison between clinical diagnoses and urodynamic diagnoses was done and frequencies were computed. The mean age of the patients was 61.1 years, the mean body mass index was 25 and mean parity was 4.1. There was a matching between clinical and urodynamic findings of stress urinary incontinence (SUI) and overactive bladder (OAB), but disparity was observed in cases of mixed urinary incontinence (MUI) and lower urinary tract symptoms (LUTS). Occult SUI was found in 33% of patients with POP. Conclusion: Key messages were derived for future practice stating that for cases of SUI and OAB, UDS are not required, but patients with complex MUI, chronic LUTS, and neurogenic bladder warrant UDS.