Mobile health may improve evaluation of lower urinary tract symptoms

Abstract

The evaluation of patients with lower urinary tract symptoms (LUTS) is primarily based on clinical history and physical examination. Measuring the frequency and severity of LUTS adds important information for the characterization and management of lower urinary tract disorders (1, 2). Bladder diaries and uroflowmetry may be invaluable for symptom characterization. The recording of volume and time of each void by the patient is referred to as a frequency volume chart (FVC). Inclusion of information like fluid intake, use of pads, incontinence episodes or symptom severity is termed a bladder diary (1). The FVC provides data on total voided volume, day-time and night-time voiding frequency, nocturnal urinary volume and individual voided volumes. The maximum voided volume (MVV) is an important parameter of the voiding diary as it corresponds to the functional bladder capacity. It may be important to improve our understanding of bladder sensation, overactive bladder symptoms, polyuria and overflow incontinence (3). It may be used to clinically phenotype patients and help counseling regarding fluid intake and timed voiding (3). It may also assist in monitoring patient ́s response to treatment (2). The amount of information to be included and the duration of a bladder diary is variable, but typically should take from three to seven days (4). In this study, based on the perception that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary, the authors compared these two non-invasive methods by which MVV can be determined. They used a database of over seven hundred patients evaluated for LUTS who completed a 24-hour bladder diary independently using a smartphone application. They found that there is a difference between the two measurement tools, and that the maximum voided volume recorded in a bladder diary (BD-MVV) is usually greater than that obtained at the time of uroflow (Q-MVV). They suggested that for a more reliable assessment of MVV in men and women, both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV (5). It is important to highlight the use of a mobile app for the completion of the voiding diary in this study. Mobile health (mHealth) is an attractive and expanding tendency within LUTS care, both from the viewpoint of urologists and also by health systems and for research (6, 7). Typically, mHealth is based on a smartphone app that may help in the evaluation, monitoring and/or treatment of a health condition. mHealth has been used in urology for prostate cancer, urinary stones, LUTS, urinary incontinence and urinary tract infections and its use has gained importance with the COVID-19 pandemic (8). In the urinary stone field, apps may prevent forgetting a double-J catheter (9). For prostate cancer, apps may help physicians to stage patients and calculate disease risk and they EDITORIAL COMMENT Vol. 47 (6): 1195-1197, November December, 2021